Amblyopia is a reduction of vision in one or both eyes due to a failure of normal neural development in the immature visual system.
Amblyopia occurs due to two basic conditions – abnormal binocular interaction (e.g., strabismus) and blurring or distortion of visual image due to uncorrected refractive errors or media opacities. Best-corrected visual acuities in amblyopic eyes range from mild deficits to severe vision loss.
The principle of treating amblyopia involves clearing any image blur and encouraging use of the amblyopic eye with occlusion of the better-seeing eye. Paediatric Eye Disease Investigator Group (PEDIG) studies show that both part-time and full-time occlusions can produce similar results in the eye with severe amblyopia and occlusion can be prescribed initially at 2 hours per day for the moderate amblyope. Studies show that daily atropine and patching for 6 hours/day can be equivalent treatment options and that if pharmacologic blurring is used for treatment, initial treatment can begin with just weekend use of atropine for moderate amblyopia.
Amblyopia can lead to permanent loss of vision; therefore vision screening is strongly recommended over the course of childhood to detect amblyopia early enough to allow successful treatment.
Kerr NC. Advances in the Management of Amblyopia. In: 2010 Focal point collection. San Francisco: American Academy of Ophthalmology; 2010.
de Zárate BR, Tejedor J. Current concepts in the management of amblyopia. Clin Ophthalmol. 2007 Dec;1(4):403–14. PMID:19668517
Webber AL, Wood J. Amblyopia: prevalence, natural history, functional effects and treatment. Clin Exp Optom. 2005 Nov;88(6):365–75. https://doi.org/10.1111/j.1444-0938.2005.tb05102.x PMID:16329744
Newman DK, East MM. Prevalence of amblyopia among defaulters of preschool vision screening. Ophthalmic Epidemiol. 2000 Mar;7(1):67–71. https://doi.org/10.1076/0928-6586(200003)711-2FT067 PMID:10652173
Carlton J, Kaltenthaler E. Amblyopia and quality of life: a systematic review. Eye (Lond). 2011 Apr;25(4):403–13. https://doi.org/10.1038/eye.2011.4 PMID:21274010
Gardaševič I, Kosec D. Slabovidnost. Zdrav Vestn. 2005;74:669–71.
Hamm LM, Black J, Dai S, Thompson B. Global processing in amblyopia: a review. Front Psychol. 2014 Jun;5:583. https://doi.org/10.3389/fpsyg.2014.00583 PMID:24987383
Gunton KB. Advances in amblyopia: what have we learned from PEDIG trials? Pediatrics. 2013 Mar;131(3):540–7. https://doi.org/10.1542/peds.2012-1622 PMID:23382445
Sloper J. The other side of amblyopia. J AAPOS. 2016 Feb;20(1):1.e1–13. https://doi.org/10.1016/j.jaapos.2015.09.013 PMID:26917086
Maconachie GD, Gottlob I. The challenges of amblyopia treatment. Biomed J. 2015 Dec;38(6):510–6. https://doi.org/10.1016/j.bj.2015.06.001 PMID:27013450
Amblyopia. Preferred Practice Pattern. San Francisco: American Academy of Ophthalmology; 2012.
Brown HD, Woodall RL, Kitching RE, Baseler HA, Morland AB. Using magnetic resonance imaging to assess visual deficits: a review. Ophthalmic Physiol Opt. 2016 May;36(3):240–65. https://doi.org/10.1111/opo.12293 PMID:27112223
Klimek DL, Cruz OA, Scott WE, Davitt BV. Isoametropic amblyopia due to high hyperopia in children. J AAPOS. 2004 Aug;8(4):310–3. https://doi.org/10.1016/j.jaapos.2004.05.007 PMID:15314589
Donahue SP, Arnold RW, Ruben JB; AAPOS Vision Screening Committee. Preschool vision screening: what should we be detecting and how should we report it? Uniform guidelines for reporting results of preschool vision screening studies. J AAPOS. 2003 Oct;7(5):314–6. https://doi.org/10.1016/S1091-8531(03)00182-4 PMID:14566312
Weakley DR Jr. The association between nonstrabismic anisometropia, amblyopia, and subnormal binocularity. Ophthalmology. 2001 Jan;108(1):163–71. https://doi.org/10.1016/S0161-6420(00)00425-5 PMID:11150283
Sjöstrand J, Abrahamsson M. Risk factors in amblyopia. Eye (Lond). 1990;4(Pt 6):787–93. https://doi.org/10.1038/eye.1990.124 PMID:2101108
Simmers AJ, Gray LS, Spowart K. Screening for amblyopia: a comparison of paediatric letter tests. Br J Ophthalmol. 1997 Jun;81(6):465–9. https://doi.org/10.1136/bjo.81.6.465 PMID:9274410
Holmes JM, Kraker RT, Beck RW, Birch EE, Cotter SA, Everett DF, et al.; Pediatric Eye Disease Investigator Group. A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children. Ophthalmology. 2003 Nov;110(11):2075–87. https://doi.org/10.1016/j.ophtha.2003.08.001 PMID:14597512
Repka MX, Beck RW, Holmes JM, Birch EE, Chandler DL, Cotter SA, et al.; Pediatric Eye Disease Investigator Group. A randomized trial of patching regimens for treatment of moderate amblyopia in children. Arch Ophthalmol. 2003 May;121(5):603–11. https://doi.org/10.1001/archopht.121.5.603 PMID:12742836
Shah M, Murthy R. Amblyopia treatment. Ophthalmology. 2009 Aug;116(8):1588–9. https://doi.org/10.1016/j.ophtha.2009.03.036 PMID:19651315
Gottlob I, Awan M, Proudlock F. The role of compliance in 2 vs 6 hours of patching in children with amblyopia. Arch Ophthalmol. 2004 Mar;122(3):422–3. https://doi.org/10.1001/archopht.122.3.422-b PMID:15006872
Repka MX, Kraker RT, Beck RW, Holmes JM, Cotter SA, Birch EE, et al.; Pediatric Eye Disease Investigator Group. A randomized trial of atropine vs patching for treatment of moderate amblyopia: follow-up at age 10 years. Arch Ophthalmol. 2008 Aug;126(8):1039–44. https://doi.org/10.1001/archopht.126.8.1039 PMID:18695096
Repka MX, Cotter SA, Beck RW, Kraker RT, Birch EE, Everett DF, et al.; Pediatric Eye Disease Investigator Group. A randomized trial of atropine regimens for treatment of moderate amblyopia in children. Ophthalmology. 2004 Nov;111(11):2076–85. https://doi.org/10.1016/j.ophtha.2004.04.032 PMID:15522375
Holmes JM, Beck RW, Kraker RT, Astle WF, Birch EE, Cole SR, et al.; Pediatric Eye Disease Investigator Group. Risk of amblyopia recurrence after cessation of treatment. J AAPOS. 2004 Oct;8(5):420–8. https://doi.org/10.1016/S1091-8531(04)00161-2 PMID:15492733
Levartovsky S, Oliver M, Gottesman N, Shimshoni M. Factors affecting long term results of successfully treated amblyopia: initial visual acuity and type of amblyopia. Br J Ophthalmol. 1995 Mar;79(3):225–8. https://doi.org/10.1136/bjo.79.3.225 PMID:7703198
Astle AT, Webb BS, McGraw PV. Can perceptual learning be used to treat amblyopia beyond the critical period of visual development? Ophthalmic Physiol Opt. 2011 Nov;31(6):564–73. https://doi.org/10.1111/j.1475-1313.2011.00873.x PMID:21981034
Scheiman MM, Hertle RW, Beck RW, Edwards AR, Birch E, Cotter SA, et al.; Pediatric Eye Disease Investigator Group. Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol. 2005 Apr;123(4):437–47. https://doi.org/10.1001/archopht.123.4.437 PMID:15824215
Sengpiel F. Plasticity of the visual cortex and treatment of amblyopia. Curr Biol. 2014 Sep;24(18):R936–40. https://doi.org/10.1016/j.cub.2014.05.063 PMID:25247373
Holmes JM, Beck RW, Kraker RT, Cole SR, Repka MX, Birch EE, et al.; Pediatric Eye Disease Investigator Group. Impact of patching and atropine treatment on the child and family in the amblyopia treatment study. Arch Ophthalmol. 2003 Nov;121(11):1625–32. https://doi.org/10.1001/archopht.121.11.1625 PMID:14609923
Suttle CM. Active treatments for amblyopia: a review of the methods and evidence base. Clin Exp Optom. 2010 Sep;93(5):287–99. https://doi.org/10.1111/j.1444-0938.2010.00486.x PMID:20533925
Tsirlin I, Colpa L, Goltz HC, Wong AM. Behavioral Training as New Treatment for Adult Amblyopia: A Meta-Analysis and Systematic Review. Invest Ophthalmol Vis Sci. 2015 Jun;56(6):4061–75. https://doi.org/10.1167/iovs.15-16583 PMID:26114483
Campos EC, Fresina M. Medical treatment of amblyopia: present state and perspectives. Strabismus. 2006 Jun;14(2):71–3. https://doi.org/10.1080/09273970600701044 PMID:16760111
Leguire LE, Rogers GL, Bremer DL, Walson PD, McGregor ML. Levodopa/carbidopa for childhood amblyopia. Invest Ophthalmol Vis Sci. 1993 Oct;34(11):3090–5. PMID:8407216
Schmucker C, Grosselfinger R, Riemsma R, Antes G, Lange S, Lagrèze W, et al. Effectiveness of screening preschool children for amblyopia: a systematic review. BMC Ophthalmol. 2009 Jul;9(1):3. https://doi.org/10.1186/1471-2415-9-3 PMID:19607693
Doshi NR, Rodriguez ML. Amblyopia. Am Fam Physician. 2007 Feb;75(3):361–7. PMID:17304867
Atkinson J, Braddick O, Pimm-Smith E. ‘Preferential looking’ for monocular and binocular acuity testing of infants. Br J Ophthalmol. 1982 Apr;66(4):264–8. https://doi.org/10.1136/bjo.66.4.264 PMID:7066282
Copyright (c) 2019 Slovenian Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.