Guideline:
Care of the patient with amblyopia
Bibliographic Source(s)
- American Optometric Association. Care of the patient with amblyopia. 2nd ed. St. Louis (MO): American Optometric Association; 1997. 57 p. (Optometric clinical practice guideline; no. 4). [177 references]
Guideline Status
This is the current release of the guideline.
According to the guideline developer this guideline has been reviewed on a biannual basis and is considered to be current as of 2004. This review process involves updated literature searches of electronic databases and expert panel review of new evidence that has emerged since the original publication date.
Guideline Category
Diagnosis
Evaluation
Management
Intended Users
Health Plans
Optometrists
Guideline Objective(s)
- To identify patients at risk of developing amblyopia
- To accurately diagnose amblyopia
- To improve the quality of care rendered to patients with amblyopia
- To minimize the adverse effects of amblyopia
- To preserve the gains obtained through treatment
- To inform and educate parents patients and other health care practitioners about the visual complications of amblyopia and the availability of treatment
Target Population
Children and adults suspected of having amblyopia
Interventions and Practices Considered
Diagnosis of Amblyopia
- Patient History
- 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
- Optical Correction
- Occlusion
- Active Vision Therapy
- Patient Education
Major Outcomes Considered
Not stated
Methods Used to Collect/Select Evidence
Hand-searches of Published Literature (Primary Sources)
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
The guideline developer performed literature searches using the National Library of Medicine's Medline database and the VisionNet database.
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus (Committee)
Rating Scheme for the Strength of the Evidence
Not stated
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
Not applicable
Methods Used to Formulate the Recommendations
Not stated
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Internal Peer Review
Description of Method of Guideline Validation
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.
Major Recommendations
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
- Patient History
- Visual acuity
- Refraction (noncycloplegic and cycloplegic)
- Monocular fixation
- Ocular motor deviation
- Sensorimotor fusion
- Accomodation
- Ocular motility
- Ocular health assessment and systemic health screening
- Supplemental testing
- Electrodiagnostic testing
- 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 visualacuity 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 amblyopiaand strabismic amblyopia are discussed in greater detail in the guideline document.
The frequency and composition of evaluation and management visits for amblyopia aresummarized in the following table:
Type of Patients | Evaluation Visits | Prognosis1 | Treatment Options2 | Frequency of FU visits | Estimated Total VT visits3 | Composition of FU Evaluations | |||
| VA | REF | MF | BS | ||||||
| Monocular Form Deprivation Amblyopia | 1-2 | Fair (if diagnosed and treated during critical period) |
|
| Each visit | Each visit | -------- | Each visit | |
| Binocular Form Deprivation Amblyopia | 1-2 | Fair (if diagnosed and treated during critical period) |
|
| Each visit | Each visit | -------- | Each visit | |
| Isometropic Refractive Amblyopia | 1-2 | Good |
|
| 10-15 | Each visit | PRN | PRN | Each visit |
| Anisometropic Refractive Amblyopia | 1-2 | Good |
|
| 15-25 | Each visit | PRN | PRN | Each visit |
| Strabismic Amblyopia (Central Fixation) | 1-2 | Good |
|
| 15-25 | Each visit | PRN | PRN | Each visit |
| Strabismic Amblyopia (Eccentric Fixation) | 1-2 | Fair |
|
| 25-35 | Each visit | PRN | Each visit | Each visit |
1
General prognosis; prognosis is improved during critical sensitive periodof development but compliance and motivation afford improvements into adulthood.2 Surgery is indicated in cases of congenital cataract and ptosis.
3 Estimated visits may vary based on co-existing conditions patient compliance etc.
VA = visual acuity REF = refractive status MF = monocular fixation BS = binocular status FU = follow-up visit VT = vision therapy PRN = as necessary
Clinical Algorithm(s)
An algorithm is provided for Optometric Management of the Patient with Amblyopia.
Type of Evidence supporting the Recommendations
The type of supporting evidence is not specifically stated for each recommendation.
Potential Benefits
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.
Potential Harms
Not stated
Qualifying Statements
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.
Description of Implementation Strategy
An implementation strategy was not provided.
IOM Care Need
Getting Better
Staying Healthy
IOM Domain
Effectiveness
Patient-centeredness
Bibliographic Source(s)
- American Optometric Association. Care of the patient with amblyopia. 2nd ed. St. Louis (MO): American Optometric Association; 1997. 57 p. (Optometric clinical practice guideline; no. 4). [177 references]
Adaptation
Not applicable: The guideline was not adapted from another source.
Source(s) of Funding
Funding was provided by the Vision Service Plan (Rancho Cordova California) and its subsidiary Altair Eyewear (Rancho Cordova California)
Guideline Committee
American Optometric Association Consensus Panel on Care of the Patient with Amblyopia
Composition of Group that Authored the Guideline
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.
Financial Disclosures/Conflicts of Interest
Not stated
Guideline Status
This is the current release of the guideline.
According to the guideline developer this guideline has been reviewed on a biannual basis and is considered to be current as of 2004. This review process involves updated literature searches of electronic databases and expert panel review of new evidence that has emerged since the original publication date.
Guideline Availability
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
Availability of Companion Documents
None available
Patient Resources
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.
NGC STATUS
This summary was completed by ECRI on December 2 1999. The information was verified by the guideline developer as of January 27 2000.
COPYRIGHT STATEMENT
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.
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