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• Red reflex
• Ocular alignment - should be perfect
• Visual acuity - allen figures or similar
– each eye tested separately
– vision should be equal and 20/40 or better in each
eye (consider the child)
– refer for vision < 20/40 or 2 line difference, (i.e.
20/25 one eye, 20/40 other)
• External, anterior segment
• Ophthalmoscopic exam
Amblyopia: Prevention/Early
Treatment - 6+ Year Checks
• Red reflex
• Ocular alignment - perfect
• Visual acuity - snellen letters preferable
– vision should be 20/30 or better (consider the child)
– refer for vision < 20/30 or 2 line difference (i.e. 20/20
one eye, 20/30 other)
• External, anterior segment
• Ophthalmoscopic exam
Amblyopia: Conclusion
• Straighten the eyes
• Clear the media
• Correct the refractive error
Amblyopia: Conclusion
• Diagnose it early!
Amblyopia Case Histories
Amblyopia Case Histories: JH
• 7 1/2 year white female failed school
screening exam
• Uncorrected acuity 20/20 RE, 20/200 LE
• Other information?
Amblyopia Case Histories: JH
• Ocular motility: barely perceptible
esotropia
• Stereo vision: nil
• Ocular structures: normal
Amblyopia Case Histories: JH
• Cycloplegic Refraction
– RE +0.25 D
– LE +4.75 D
• Treatment
– glasses
– patch right eye
• Result at one month, 20/60 LE, continue
patching
Amblyopia Case Histories: JH
• Prevention
– Bruckner’s test of red reflex
– Acuity screening yearly
Amblyopia Case Histories: SP
• Treatment plan
– cataract removal/lens implant
• first eye - exotropia better indicating possible
fusion
• second eye surgery also
Amblyopia Case Histories: LB
• 2 3/4 y.o. black male
• Gets “real close” to TV -
mom demonstrates few
inches
• Mom feels he can see
her across room
• She only thinks there is a
problem when he’s
watching TV or playing
with his cars
Amblyopia Case Histories: LB
• Acuity: fix and follow (normal for his age)
• Ocular alignment: normal
• Anterior segment exam: normal
Amblyopia Case Histories: LB
• Bruckner’s test - dull but equal reflexes
Amblyopia Case Histories: LB
• Refraction: -10.50 D both eyes
• Treatment: glasses full time
• Expected outcome: excellent vision
– caught at young age
– equal refraction
Bruckner’s Test of Red Reflex
• direct ophthalmoscope at 0 setting, otoscope
without magnifyer
• distance of 2 feet from patient
• normal - equal red reflex
• unequal refraction - one eye darker reflex
• no/poor reflex - media opacity
• corneal light reflex not symmetric - strabismus
Amblyopia Case Histories: LB
• 2 3/4 y.o. black male
• Gets “real close” to TV - mom demonstrates few
inches
• Mom feels he can see her across room
• She only thinks there is a problem when he’s
watching TV or playing with his cars
MTI Photoscreener
• 6 year old white female referred for
evaluation of “possible
amblyopia/strabismus”
MTI Photoscreener
MTI Photoscreener
• Visual acuity without correction
Right eye 20/25
Left eye 20/400
• Ocular motility
Trace esotropia
MTI Photoscreener
• Cycloplegic refraction
Right eye +1.75
Left eye +6.00 (20/200 best acuity)
• Diagnosis
Amblyopia secondary to anisometropia
(unequal focus between the eyes)
• Prognosis: Very good with patch and
glasses
Photographs
For your enjoyment