From the Guidelines
Amblyopia, commonly known as "lazy eye," is a vision development disorder where the brain favors one eye over the other, leading to reduced vision in the weaker eye. It typically develops during early childhood when the brain and visual system are still developing 1. The condition occurs when one eye doesn't receive proper visual stimulation, causing the brain to gradually ignore signals from that eye. Common causes include:
- Strabismus (eye misalignment)
- Significant differences in refractive error between eyes
- Visual deprivation from conditions like cataracts 1.
Key Points
- Treatment is most effective when started early, ideally before age 7, and typically involves correcting any underlying problems with glasses, then forcing the brain to use the weaker eye through patching the stronger eye or using atropine eye drops 1.
- Without treatment, amblyopia can lead to permanent vision loss in the affected eye, as the visual pathways between the eye and brain don't develop properly during the critical period of visual development in childhood 1.
- The most recent and highest quality study recommends that treatment of refractive error alone can improve visual acuity in children who have anisometropic, strabismic, or combined amblyopia 1.
Treatment Options
- Optical correction
- Patching
- Pharmacological treatment
- Optical treatment
- Bangerter (translucent) filters
- Digital therapeutics, in addition to managing the underlying cause of amblyopia 1.
Importance of Early Detection
- Identifying children at risk for amblyopia and examining them at the earliest possible age is crucial for effective treatment 1.
- Informing the patient, family/caregiver, and primary care provider about the diagnosis, treatment options, care plan, and prognosis is also essential 1.
From the FDA Drug Label
1.3 Penalization of the healthy eye in the treatment of amblyopia The answer to what amblyopia is, is not directly provided in the drug label.
- Amblyopia is mentioned as an indication for the use of atropine sulfate ophthalmic solution, but its definition is not provided. 2
From the Research
Definition and Overview of Amblyopia
- Amblyopia is the leading cause of monocular vision loss in children 3
- It is a condition where there is a loss of vision in one eye due to abnormal development during childhood
Causes and Risk Factors
- Amblyopia can be caused by strabismus, anisometropia, or other factors that affect the development of the visual system 3, 4
- Risk factors for amblyopia include family history, premature birth, and certain medical conditions 3
Diagnosis and Screening
- The U.S. Preventive Services Task Force recommends vision screening for all children at least once between three and five years of age to detect the presence of amblyopia or its risk factors 3
- Routine, age-appropriate red reflex testing, examination for signs of strabismus, and vision chart testing are also recommended 3
Treatment Options
- Treatments for amblyopia include patching, atropine eye drops, and optical penalization of the nonamblyopic eye 3, 5, 6
- Combined atropine and patching therapy (CAPT) has been found to be efficacious for severe amblyopia 4
- Novel approaches targeted to the restoration of binocular functions, such as perceptual learning, video gaming, and dichoptic training, have shown small effects on visual acuity 6
Treatment Outcomes and Prognosis
- Children younger than seven years receive the most benefit from treatment, but older children may still benefit 3, 5
- Amblyopia recurs in 25% of children, so continued surveillance is important 3
- Treatment efficiency declines with age, but recent evidence indicates cortical plasticity beyond the "critical period" 6, 7