儿童斜弱视

by Dr. John Hsiao

　　萧清仁

　　between age 6 months and 6 yrs. Old (US Study)

　　-33%  Hyperopia

　　-22.5%  Astigmatism

　　-9.5%  Myopia

　　-5%  Binocular vision disorder

　　-21.1%  Strabismus

　　-7.9%  Amblyopia

　　-1%  Accommodative disorder

　　Amblyopic
　　Monocular reduced VA not by pathology or refraction error.

　　-Characteristics(strab/Ref):

　　3 causes- strabismus, refractive, deprivation.

　　Strabismus (amblyopia of arrest)-VA never achieved b/c hasn’t been used

　　Refractive(amblyopia of extinction)- VA lost due to cortical inhibition from the good eye

　　Deprivation (ie. Congenital cataract)

 　　Amblyopia Work-up
　　1. cycloplegic refraction- to rule out the possibility of latent hyperopia, accom spasm  consider binocular refraction instead

　　2. Pinhole- if improvement but still not 20/20, further testing all with PH

　　3. IFA testing- do freg seeing curve-use tumbling E’s out of 4

　　a. if IFA= IA, then it’s amblyopia of arrest

　　b. if IFA= 20/20, amblyopia of extinction

　　c. if IA< IFA< 20/20, partial due to amblyopia

　　4. test for eccentric fixation- for visuoscopy, test preferred eye first,

　　5. BV assessment: unilateral cover test, alternating cover test, 4D prism

　　6. Ocular health assessment; color vision for Optic nerve dysfunction, Amsler Grid, Pupil test, fundus, ND filter, VER’s

 　　Prognosis:

　　Case Hx; child’s diseases?, cataract?

　　Major prediction-if IFA>IA---good

　　-any strab, onset, freg, laterality,

　　-center fixation—good, unsteady eccentric fixation is better than steady

　　- refractive, extinction-good, strab, arrest—bad

　　- bifoveal fixation important if ARC stops bifoveal, cause of amblyopia cannot be removed

　　- previous training? Severity?

　　- Myopia-good, hyperopia-bad

　　- Age, health, motivation

　　Goal: spare eye at least 20/40

　　Treatment;

　　1. refraction (eg. Aniseikonia)

　　-convert unilateral strab to alternating

　　-eliminate eccentric fixation

　　2. monocular stimulation under binocular condition

　　-modified Brock

　　3. patching 5 hr/day for 6 weeks                     

　　- exercise, pick up sticks

　　- concern: if tenuous fusion ie. Intermittent strabismus- after patching may get diplopia or constant strabismus. Use anti-suppression, ie. Modified Brock

　　- follow –up, if patch :very 2 weeks, watch for occlusion amblyopia

　　- once treated, maintain program or stop therapy

　　4. monovision

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