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Amblyopia Treatment

  • Kenneth W. Wright
  • Yi Ning J. Strube

Abstract

Amblyopia is poor vision caused by abnormal visual stimulation during early visual development. The abnormal visual stimulation disrupts neurodevelopment of visual centers in the brain. Abnormal stimulation can arise from a blurred retinal image, or strabismus with strong fixation preference for one eye and cortical suppression of the nondominant eye. Children under 8 years of age are capable of strong cortical suppression and hence can eliminate double vision. Children who alternate fixation and use either eye will alternate suppression and do not develop amblyopia. The vertical prism induced tropia test can be used to determine fixation preference and diagnose unilateral amblyopia in preverbal children with straight eyes or small-angle strabismus [1]. This test is performed by placing a vertically oriented 10 PD prism over one eye, either base down or base up. The vertical prism induces a hypertropia, allowing evaluation of fixation preference. Strong fixation preference for one eye is indicative of amblyopia [2]. Amblyopia can be bilateral in children with bilateral blurred retinal images (e.g., bilateral congenital cataracts, or bilateral high hypermetropia >+5.00 sphere).

Keywords

Amblyopia Vertical prism induced tropia test Strabismus fixus Refractive error requiring correction Anisometropia Hypermetropia Myopia Astigmatism Occlusion therapy Patching Atropine Penalization therapy 

Supplementary material

Video 1

Table of Contents (MP4 316 KB)

Video 2

Drape Placement Exposing Both Eyes (MP4 12,747 KB)

Video 3

Left Eye Medical Rectus Wright Plication - Fornix (MP4 125,346 KB)

Video 4

Right Eye Lateral Rectus Resection - Fornix (MP4 56,560 KB)

Video 5

Left Eye Inferior Oblique Anteriorisation with Wright Hook (MP4 101,333 KB)

Video 6

Left Eye Inferior Oblique Anteriorisation with Traction Suture (MP4 30,548 KB)

Video 7

Right Eye Harada Ito (MP4 81,183 KB)

Video 8

Right Eye Wright Superior Oblique Tendon Expander (MP4 90,418 KB)

Video 9

Left Eye Medial Rectus Stretched Scar (MP4 110,065 KB)

Video 10

Right Eye Lost-Slipped Medial Rectus (MP4 101,076 KB)

Video 11

Right Eye Removal Lower Lid Retractors (MP4 29,184 KB)

Video 12

Right Eye Inferno - Temporal Fornix Conjunctival Closure (MP4 15,042 KB)

Video 13

Left Eye Superior Rectus Recession Reoperation (MP4 153,614 KB)

Video 14

Left Eye Medial Rectus Recession - Topical Anesthesia - Limbal (MP4 26,767 KB)

Video 15

Right Eye Lateral Rectus Recession with Wright Hook - Fornix (MP4 150,169 KB)

Video 16

Left Eye Medial Rectus Recession with Wright Hook - Fornix (MP4 113,534 KB)

Video 17

Strabismus Surgery - Strategies and Techniques (MP4 639 KB)

References

  1. 1.
    Wright KW, Walonker F, Edelman P. 10-Diopter fixation test for amblyopia. Arch Ophthalmol. 1981;99:1242–6.CrossRefGoogle Scholar
  2. 2.
    Wright KW, Edelman PM, Walonker F, Yiu S. Reliability of fixation preference testing in diagnosing amblyopia. Arch Ophthalmol. 1986;104:549–53.CrossRefGoogle Scholar
  3. 3.
    Pediatric Eye Disease Investigator Group. Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol. 2005;123:437–47.CrossRefGoogle Scholar
  4. 4.
    Wright KW, Guyton DL. A test for predicting the effectiveness of penalization on amblyopia. In: Henkind P, editor. Acta: XXIV International Congress of Ophthalmology. Philadelphia: JB Lippincott; 1983. p. 896–901.Google Scholar
  5. 5.
    Pediatric Eye Disease Investigator Group. The course of moderate amblyopia treated with atropine in children: experience of the amblyopia treatment study. Am J Ophthalmol. 2003;136:630–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Kenneth W. Wright
    • 1
  • Yi Ning J. Strube
    • 2
  1. 1.Wright Foundation for Pediatric Ophthalmology and Adult Strabismus Medical CenterLos AngelesUSA
  2. 2.Queen’s UniversityKingstonCanada

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