AMBLYOPIAAMBLYOPIA

Dr. NITISHDr. NITISH

AMBLYOPIAAMBLYOPIAU/L OR B/L DECREASE OF VISUAL U/L OR B/L DECREASE OF VISUAL

FUNCTIONS CAUSED BY FORM VISION FUNCTIONS CAUSED BY FORM VISION DEPRIVATION &/OR ABNORMAL DEPRIVATION &/OR ABNORMAL BINOCULAR INTERACTIONS THAT BINOCULAR INTERACTIONS THAT CANNOT BE EXPLAINED BY A CANNOT BE EXPLAINED BY A DISORDER OF OCULAR MEDIA OR DISORDER OF OCULAR MEDIA OR VISUAL PATHWAYSVISUAL PATHWAYS

A DIFFERENCE OF 2 LINES ON VISUAL A DIFFERENCE OF 2 LINES ON VISUAL ACUITY CHART ACUITY CHART

CLASSIFICATIONCLASSIFICATION STRABISMICSTRABISMIC ANISOMETROPIC/ ASYMMETRIC/ U/LANISOMETROPIC/ ASYMMETRIC/ U/L FORM VISION DEPRIVATIONFORM VISION DEPRIVATION STIMULUS DEPRIVATION AMBLYOPIA EXANOPSIA STIMULUS DEPRIVATION AMBLYOPIA EXANOPSIA AMETROPIC AMBLYOPIAAMETROPIC AMBLYOPIA NYSTAGMUS RELATEDNYSTAGMUS RELATED ORGANIC ORGANIC SUBCLINICAL MACULAR DAMAGESUBCLINICAL MACULAR DAMAGE MALORIENTATION OF CONESMALORIENTATION OF CONES CONE DEFICIENCY SYNDROMECONE DEFICIENCY SYNDROME

STRAIGHT EYE AMBLYOPIASTRAIGHT EYE AMBLYOPIAANISOMETROPIC – SUPPRESSION ANISOMETROPIC – SUPPRESSION

BEGINS WHEN ACCOMMODATION BEGINS WHEN ACCOMMODATION STARTS BEING ACTIVE 2-3 YRS; VISUAL STARTS BEING ACTIVE 2-3 YRS; VISUAL MATURATION COMPLETE 6-7YRS.MATURATION COMPLETE 6-7YRS.

RISK FACTORS + 3.5 D SPH, +2.0 RISK FACTORS + 3.5 D SPH, +2.0 CYL,INCREASING SIMPLE ASTIGMATISM CYL,INCREASING SIMPLE ASTIGMATISM , OBLIQUE ASTIGMATISM STRABISMUS, OBLIQUE ASTIGMATISM STRABISMUS

SUPPRESSION / ANISOMETROPIC SUPPRESSION / ANISOMETROPIC AMBLYOPIAAMBLYOPIA

AMBLYOPIA WITH SQUINTAMBLYOPIA WITH SQUINT AMBLYOPIA EX ANOPSIA – OCULAR MEDIA AMBLYOPIA EX ANOPSIA – OCULAR MEDIA

OPACITIES, CONGENITAL OR TRAUMATIC OPACITIES, CONGENITAL OR TRAUMATIC CATARACT, LEUCOMA, OCCLUSION CATARACT, LEUCOMA, OCCLUSION AMBLYOPIAAMBLYOPIA

DEPTH OF AMBLYOPIA& ITS RECOVERY DEPTH OF AMBLYOPIA& ITS RECOVERY DEPENDS ONDEPENDS ON

* DEGREE OF VISUAL ACUITY BEFORE * DEGREE OF VISUAL ACUITY BEFORE INHIBITIONINHIBITION * PERIOD DURING WHICH EXTINCTION OF * PERIOD DURING WHICH EXTINCTION OF VISION REMAINED ACTIVEVISION REMAINED ACTIVE * AGE AT WHICH IT DEVELOPED* AGE AT WHICH IT DEVELOPED

CLINICAL FEATURESCLINICAL FEATURES DECREASED VISUAL ACUITY- RECOGNITIONDECREASED VISUAL ACUITY- RECOGNITION DECREASED GRATING ACUITY- RESOLUTIONDECREASED GRATING ACUITY- RESOLUTION DECREASED VERNIER ACUITY- HYPERACUITYDECREASED VERNIER ACUITY- HYPERACUITY DECREASED / LOST STEREOACUITY- HYPERACUITYDECREASED / LOST STEREOACUITY- HYPERACUITY DECREASED CONTRAST SENSITIVITY- NEURALDECREASED CONTRAST SENSITIVITY- NEURAL DECREASED BRIGHTNESS PERCEPTION- 6 TIMES DECREASED BRIGHTNESS PERCEPTION- 6 TIMES

LONGERLONGER ABNORMAL CONTOUR INTERACTION- LINEAR ACUITYABNORMAL CONTOUR INTERACTION- LINEAR ACUITY INCREASED PERCEPTION & REACTION TIMESINCREASED PERCEPTION & REACTION TIMES NASOTEMPORAL ASYMMETRIES IN RESOLUTION OF NASOTEMPORAL ASYMMETRIES IN RESOLUTION OF

VERTICAL GRATINGSVERTICAL GRATINGS MOTILITY DEFECTS IN PURSUIT, SACCADES & MOTILITY DEFECTS IN PURSUIT, SACCADES &

FIXATIONFIXATION

CROWDING PHENOMENONCROWDING PHENOMENON

VISUAL ACUITY WITH ISOLATED VISUAL ACUITY WITH ISOLATED SYMBOLS IN A UNIFORM SYMBOLS IN A UNIFORM BACKGROUND BETTER THAN THOSE BACKGROUND BETTER THAN THOSE PRESENTED IN A ROWPRESENTED IN A ROW

CRITICAL AREA OF SEPARATION 1.9 CRITICAL AREA OF SEPARATION 1.9 TO 3.8 MIN OF ARCTO 3.8 MIN OF ARC

IMPORTANT IN PROGNOSISIMPORTANT IN PROGNOSIS

CLASSIFICATION OF FIXATIONCLASSIFICATION OF FIXATION

CENTRAL/FOVEOLARCENTRAL/FOVEOLARECCENTRIC / PARAFOVEOLARECCENTRIC / PARAFOVEOLARNO FIXATION / ARRATICNO FIXATION / ARRATIC PARAMACULAR 2 - 4PARAMACULAR 2 - 4°° CENTROCAECALCENTROCAECAL PARACENTRALPARACENTRAL

DIAGNOSIS OF ECCENTRIC DIAGNOSIS OF ECCENTRIC FIXATIONFIXATION

VISUOSCOPEVISUOSCOPEEUTHYSCOPEEUTHYSCOPEBANGERTER PLEOTOPHORE, BANGERTER PLEOTOPHORE,

LOCALISER,CENTROPHORE, LOCALISER,CENTROPHORE, SEPARATION TRAINERSEPARATION TRAINER

FUNDUS PICTUREFUNDUS PICTURECOVER TESTCOVER TESTCORNEAL REFLEX TESTCORNEAL REFLEX TEST

TESTS FOR VISUAL FUNCTIONTESTS FOR VISUAL FUNCTION

ELECTRORETINOGRAPHYELECTRORETINOGRAPHYELECTROENCEPHALOGRAPHYELECTROENCEPHALOGRAPHYVISUALLY EVOKED RESPONSEVISUALLY EVOKED RESPONSE

OCCLUSIONOCCLUSIONOCCLUSION OF THE SOUND EYEOCCLUSION OF THE SOUND EYEMETHODS – ATTACHING OCCLUDER METHODS – ATTACHING OCCLUDER

TO SPECTACLES, PASTING DARK TO SPECTACLES, PASTING DARK PAPER , MATERIALS THAT FASTEN TO PAPER , MATERIALS THAT FASTEN TO SKIN, SNEAK OR SLOWLY SKIN, SNEAK OR SLOWLY INCREASING OCCLUSIONINCREASING OCCLUSION

INVERSE OCCLUSION – IN SQUINT INVERSE OCCLUSION – IN SQUINT WITH ECCENTRIC FIXATION . AFTER 5 WITH ECCENTRIC FIXATION . AFTER 5 YRS OF AGEYRS OF AGE

RED FILTER TREATMENTRED FILTER TREATMENT

TOTAL OCCLUSION SOUND EYE WITH TOTAL OCCLUSION SOUND EYE WITH RED FILTER KODAK GELATINE RED FILTER KODAK GELATINE WRATTEN FILTER , WAVE LENGTH WRATTEN FILTER , WAVE LENGTH 600-640600-640µ ON GLASS BEFORE µ ON GLASS BEFORE AMBLYOPIC EYEAMBLYOPIC EYE

CUTS OUT WHITE LIGHTCUTS OUT WHITE LIGHTRED LIGHT INCAPABLE OF RED LIGHT INCAPABLE OF

STIMULATING ECCENTRIC FIXATIONSTIMULATING ECCENTRIC FIXATION

PRISMSPRISMS

OCCLUSION OF THE SOUND EYE WITH OCCLUSION OF THE SOUND EYE WITH PRISM FOR THE AMBLYOPIC EYEPRISM FOR THE AMBLYOPIC EYE

PLEOPTICSPLEOPTICS

BANGERTER 1940BANGERTER 1940PLEOPTOPHORE , MODIFIED PLEOPTOPHORE , MODIFIED

GULLSTRAND OPHTHALMOSCOPE GULLSTRAND OPHTHALMOSCOPE ECCENTRIC FIXATION DAZZLED WITH ECCENTRIC FIXATION DAZZLED WITH BRIGHT LIGHT, FOVEA PROTECTED BRIGHT LIGHT, FOVEA PROTECTED WITH A DISC FOLLOWED BY WITH A DISC FOLLOWED BY INTERMITTENT STIMULATION OF INTERMITTENT STIMULATION OF MACULAMACULA

EUTHYMOSCOPEEUTHYMOSCOPE

CUPPERS AT GEISSENCUPPERS AT GEISSENNEGATIVE AFTER IMAGE IS EVOKED NEGATIVE AFTER IMAGE IS EVOKED

AND ENHANCED BY FLICKERING AND ENHANCED BY FLICKERING ROOM ILLUMINATIONROOM ILLUMINATION

CLEAR SPOT IN THE CENTRE OF CLEAR SPOT IN THE CENTRE OF AFTER IMAGE CORELATES WITH AFTER IMAGE CORELATES WITH FOVEA WHICH HAS REGAINED FOVEA WHICH HAS REGAINED FUNCTIONAL SUPREMACYFUNCTIONAL SUPREMACY

HAIDINGER BRUSHESHAIDINGER BRUSHES

PENALISATION METHODPENALISATION METHOD

1 % ATROPINE OINTMENT FOR SOUND 1 % ATROPINE OINTMENT FOR SOUND EYE + MIOTICS IN AMBLYOPIC EYE + MIOTICS IN AMBLYOPIC HYPERMETROPIC EYEHYPERMETROPIC EYE

CAMBRIDGE STIMULATOR CAMBRIDGE STIMULATOR TREATMENTTREATMENT

7 MINUTES A DAY OCCLUSION OF 7 MINUTES A DAY OCCLUSION OF SOUND EYE & SIMULTANEOUS SOUND EYE & SIMULTANEOUS STIMULATION OF AMBLYOPIC EYE STIMULATION OF AMBLYOPIC EYE WITH SLOWLYY ROTATING HIGH WITH SLOWLYY ROTATING HIGH CONTRAST GRATING OF HIGH CONTRAST GRATING OF HIGH SPATIAL FREQUENCYSPATIAL FREQUENCY

ADJUNCT TO OCCLUSIONADJUNCT TO OCCLUSION

LEVO DOPA CARBIDOPA 4:1 IN DOSES LEVO DOPA CARBIDOPA 4:1 IN DOSES OF 2/ 0.5 MG / KG BODY WT FOR 3 OF 2/ 0.5 MG / KG BODY WT FOR 3 WEEKS BELOW 12 YEARSWEEKS BELOW 12 YEARS