1. Amblyopia Treatment Past, Present and Future Anne Southgate Sylvie Cringle Orthoptic Department, HEFT

2. Amblyopia – what is it? Definition: – Defective visual acuity which persists after correction of any refractive error and removal of any pathological obstacle to vision. Also termed ‘lazy eye’ Types

3. Amblyopia Treatment Removal of obstacle to vision Glasses Occlusion (patching) – Conventional – Inverse Stimulation Atropine penalisation Optical penalisation

4. Early Amblyopia Treatment Total to form and light Total to form Partial to form Atropine Timing Last resort

5. Amblyopia Treatment

6. Then

7. Amblyopia Treatment Now

8. Amblyopia Treatment Then

9. Amblyopia Treatment Now

10. Amblyopia Treatment Then and now

11. Amblyopia Treatment Age group: Up to 2 ½ years of age (and/or when vision test cannot be relied on): Fixation patternAmount of occlusionReview time Alternating squint or Holding fixation} No occlusion indicatedReview 6 – 12 weeks Taking up fixation quicklyObserveReview 6-12 weeks Taking up fixation slowlyConsider 2 hours occlusion dailyReview 4-6 weeks Not taking up fixationConsider inverse occlusion See separate guidelines (section 10.3) Age group: 2 ½ years to 5 ½ years of age: VAAmount of occlusionReview time VA better than 0.6 LogMAR2-4 hoursReview 6-8 weeks VA less than 0.6 LogMAR4-6 hoursReview 4-6 weeks Age group: 5 ½ years of age and upwards: VAAmount of occlusionReview time VA better than 0.6 LogMAR2-4 hoursReview 6 weeks VA less than 0.6 LogMARConsider up to 6 hours occlusion per day dependant on other clinical considerations i.e. density of suppression, area of fixation, behaviour of child, parental views etc Review 2 weeks

12. Amblyopia Treatment Atropine

13. Amblyopia Treatment VisitDateVA Test Used Prescribed Daily Occlusion from Last Visit Average Actual Daily Occlusion Total Actual Hours of Occlusion Since Last Visit Prescribed Daily Occlusion Reason Occlusion Stopped Orthoptist RL 1 2 3 4 5 6 7 8

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