1. AMBLYOPIA - Treatment efficiency principles Dr Irina Velcea Dr Luminita Teodorescu Dr Oana Andrei CLINICA OFTALMIX SOP

2. Definition Decrease of vision, either unilaterally or bilaterally, for which no cause can be found by physical examination of the eye. Types of amblyopia:- anisometropic - strabismic - combined

3. Acuity levels for diagnosis a 2-line of difference on an acuity chart Classification: - mild: VA > 0,3 - moderate: VA= 0,1- 0,3 - severe: VA< 0,1

4. Principles of treatment Comprehensive ophthalmic examination Appropriate glasses prescription as initial treatment Patching according to a plan Careful follow-up Treatment of strabismus

5. Material and methods 166 patients Anisometropic, strabismic, combined amblyopia Mean follow-up 2 years ( minimum 6 months, maximum 7 years) Full - time occlusion or part – time occlusion ( 3-6 hours/day)

6. Recorded parameters VA at the start and the end of the treatment Refraction Measurements of the deviation Type of occlusion

7. Group description Mean age 5 years ( minimum 1 year, maximum 11 years ) Mean VA at the start of the treatment 0,3 ( minimum 0,05, maximum 0,8 ) Mean VA at the end of the treatment 0,7 ( minimum 0,1, maximum 1 ) Etiology: - strabismus 47% - anisometropia 36,7% - mixed(strabismus+anisometropia) 16,3%

8. Group description Strabismus: esotropia 94,9%, exotropia 5,1% Refraction: - hyperopic astigmatism 68,7% - hyperopia 26,5% - myopic astigmatism 4,2% - mixed astigmatism 0,6% Occlusion: 41% full-time, 51,2% part-time, 7,8% no occlusion Follow-up according to the type of occlusion and age of the child

9. Depth of amblyopia depending on etiology Etiology Amblyopia Total SevereModerateMild Strabismus7383378 Anisometropia3312761 Mixed2121327 Total128173166

10. Anisometropic amblyopia Depth of amblyopia varying with magnitude of anisometropia Amblyopia Anisometropia Total <1 D1-3 D>3 D Severe 1113 Moderate 1512431 Mild 177327 Total 3320861

11. Strabismic amblyopia Depth of amblyopia depending on the type of deviation

12. Strabismic amblyopia Depth of amblyopia depending on magnitude of deviation

13. Strabismic amblyopia Depth of amblyopia depending on strabismus onset

14. Number of gained lines varying with the type of occlusion Mean no of gained lines Full-time occlusion Part-time occlusion Severe amblyopia5,54 Moderate amblyopia4,14,2 Mild amblyopia3,62,8

15. Number of gained lines according to child’s age Mean no of gained 1-3 years3-5 years5-8 years8-11 years lines 4,323,622,553

16. Improvement in different types of amblyopia NMinimum Maximu mMean Std. Deviation Strabismic amblyopia 78093,352,547 Anisometropic 61083,642,259 amblyopia Mixed 27083,072,688 amblyopia

17. Recurrence of amblyopia 1-3 years3-5 years5-8 years8-11 years Reccurence3,382,772,052,33 71 patients ( 42,8%) had reccurences of amblyopia, more than cited in literature (25%) - 50,7% with strabismic amblyopia - 25,3% with anisometropia -24% with combined amblyopia

18. Improvement and recurrence of amblyopia depending by age

19. Conclusions Etiology does not influence the depth of amblyopia No difference in treatment response depending on etiology Anisometropia < 1 D cause moderate and mild amblyopia but in one case severe amblyopia. Optical correction is essential even in small anisometropia In severe amblyopia, full-time is more efficient than part-time occlusion (in PEDIG studies 6 hours of patching= full-time patching) In moderate and mild amblyopia, the same improvement in full and part-time patching

20. Conclusions The greatest improvement is between 1-3 years of age First ophthalmic examination before 3 years Children between 8-11 years of age showed improvement of visual acuity of 3 lines with part- time occlusion, so amblyopia treatment at this age is effective The highest risk of recurrence is between 1-3 years of age ( follow-up according to age ) Recurrences are more frequent in strabismic amblyopia Weaning before cessation of treatment reduce the chance of recurrence