Guideline:Care of the patient with amblyopia. Measure Summary

Amblyopia

Children and adults suspected of having amblyopia

Diagnosis of Amblyopia

1. Patient History
2. Ocular Examination
   • Visual Acuity
   • Refraction
   • Monocular fixation
   • Ocular motor deviation
   • Sensorimotor fusion
   • Accommodation
   • Ocular motility
   • Ocular health assessment and systemic health screening

Management of Amblyopia

1. Optical Correction
2. Occlusion
3. Active Vision Therapy
4. Patient Education

Not stated

The guideline developer performed literature searches using the National Library of Medicine's Medline database and the VisionNet database.

2009 Review Process

The principal author of the guideline and primary American Optometric Association staff performed searches of PubMed and Cochrane Collaboration using relevant keywords. The Clinical Guidelines Coordinating Committee reviews staff literature searches conducted for each guideline. The committee then determines which guidelines should be reviewed by the consensus panel, revised by the principal author and panel, or completely rewritten.

Not stated

Not stated

Not applicable

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

The Reference Guide for Clinicians was reviewed by the American Optometric Association (AOA) Clinical Guidelines Coordinating Committee and approved by the AOA Board of Trustees.

Summarized by the National Guideline Clearinghouse (NGC):

Diagnosis of Amblyopia

The evaluation of a patient with amblyopia may include, but is not limited to the following areas. These examination components are not intended to be all inclusive because professional judgment and the individual patient's symptoms and findings may have a significant impact on the nature, extent, and course of the services provided. Each component is described in greater detail in the guideline document.

Potential Components of the Diagnostic Evaluation for Amblyopia

1. Patient History
2. Visual acuity
3. Refraction (noncycloplegic and cycloplegic)
4. Monocular fixation
5. Ocular motor deviation
6. Sensorimotor fusion
7. Accomodation
8. Ocular motility
9. Ocular health assessment and systemic health screening
10. Supplemental testing
    1. Electrodiagnostic testing
    2. Additional differential diagnostic testing

Management of amblyopia

Treatment should be directed toward the two primary etiologies of amblyopia: form deprivation and binocular inhibition. Amblyopia therapy effectively restores normal or near-normal visual function by eliminating eccentric fixation and/or developing more extensive synaptic input to the visual cortex. It improves monocular deficits of visual acuity, monocular fixation, accommodation, and ocular motility. The final step in amblyopia therapy, if possible, is to develop normal binocular vision. The establishment of binocular vision eliminates or significantly reduces the underlying binocular inhibition in unilateral amblyopia, which increases the probability of maintaining visual acuity improvements.

The following treatment options are discussed in greater detail in the guideline document:

• Optical correction
• Occlusion
• Active vision therapy

Management of deprivation amblyopia, isometropic amblyopia, anisometropic amblyopia, and strabismic amblyopia are discussed in greater detail in the guideline document.

The frequency and composition of evaluation and management visits for amblyopia are summarized in the following table:

VA = visual acuity, REF = refractive status, MF = monocular fixation, BS = binocular status, FU = follow-up visit, VT = vision therapy, PRN = as necessary

An algorithm is provided for Optometric Management of the Patient with Amblyopia.

The type of supporting evidence is not specifically stated for each recommendation.

The prevalence, potential risks, and possible costs of untreated amblyopia contrasted with the good prognosis for patients treated at any age necessitate the involvement of optometrists in the diagnosis and treatment, or referral for consultation of patients with amblyopia.

Not stated

Clinicians should not rely on this Clinical Guideline alone for patient care and management. Please refer to the references and other sources listed in the original guideline for a more detailed analysis and discussion of research and patient care information.

An implementation strategy was not provided.

Not applicable: The guideline was not adapted from another source.

Funding was provided by the Vision Service Plan (Rancho Cordova, California) and its subsidiary Altair Eyewear (Rancho Cordova, California)

American Optometric Association Consensus Panel on Care of the Patient with Amblyopia

Members: Michael W. Rouse, O.D., M.S. (Principal Author); Jeffrey S. Cooper, O.D., M.S.; Susan A. Cotter, O.D.; Leonard J. Press, O.D.; Barry M. Tannen, O.D.

AOA Clinical Guidelines Coordinating Committee Members: John F. Amos, O.D., M.S. (Chair); Kerry L. Beebe, O.D.; Jerry Cavallerano, O.D., Ph.D.; John Lahr, O.D.; Richard Wallingford, Jr., O.D.

Not stated

This is the current release of the guideline.

According to the guideline developer, this guideline was last reviewed for currency in 2009.

Electronic copies: Available from the American Optometric Association Web site .

Print copies: Available from the American Optometric Association, 243 N. Lindbergh, Blvd., St. Louis, MO 63141-7811

None available

The following is available:

• Answers to your questions about lazy eye. St. Louis, MO: American Optometric Association. (Patient information pamphet).

Print copies: Available from the American Optometric Association, 243 N. Lindbergh Blvd., St. Louis, MO 63141-7881; Web site, www.aoanet.org .

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

This summary was completed by ECRI on December 2, 1999. The information was verified by the guideline developer as of January 27, 2000. The information was reaffirmed by the guideline developer in 2009 and updated by ECRI Institute on February 26, 2010.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions as follows:

Copyright to the original guideline is owned by the American Optometric Association (AOA). NGC users are free to download a single copy for personal use. Reproduction without permission of the AOA is prohibited. Permissions requests should be directed to Jeffrey L. Weaver, O.D., Director, Clinical Care Group, American Optometric Association, 243 N. Lindbergh Blvd., St. Louis, MO 63141; (314) 991-4100, ext. 244; fax (314) 991-4101; e-mail, ClinicalGuidelines@theAOA.org.