Management of amblyopia in pediatric patients: Current insights

Abstract

Amblyopia is a cause of significant ocular morbidity in pediatric population and may lead to visual impairment in future life. It is caused due to formed visual deprivation or abnormal binocular interactions. Several risk factors in pediatric age group may lead to this disease. Author groups have tried managing different types of amblyopia, like anisometropic amblyopia, strabismic amblyopia and combined mechanism amblyopia, with optical correction, occlusion therapy, penalization, binocular therapy and surgery. We review historical and current management strategies of different types of amblyopia affecting children and outcomes in terms of visual acuity, binocularity and ocular deviation, highlighting evidence from recent studies. Literature searches were performed through Pubmed. Risk factors for amblyopia need to be identified in pediatric population as early in life as possible and managed accordingly, as visual outcomes in amblyopia are best if treated at the earliest. Although, monocular therapies like occlusion or penalization have been shown to be quite beneficial over the years, newer concepts related to binocular vision therapy are still evolving.

Non-Surgical Strabismus Treatment

“…It develops at an early age, as a result of suppression of the image from the deviated eye, or eye with uncorrected refractive error, or some kind of anatomical disorder (cataract, ptosis, hemangioma), the part of cortex responsible for interpreting the images coming from eye does not receive the stimulation necessary for normal development. As a result of untreated amblyopia, the affected eye develops lower visual acuity due to the abnormal development of the cortical visual pathway or abnormal binocular interactions [23][24][25][26].…”

“…In such cases, atropine penalization and filters are prescribed. These methods are used less frequently but are also useful [14,16,26,27]. Penalization is effective if the vision of the better-seeing eye under conditions of penalization is lower than the visual acuity of the amblyopic eye.…”

Management of Contact Lenses and Visual Development in Pediatric Aphakia

“…An inadequate retinal image during this sensitive period hinders the formation of good visual perception in the occipital cortex and negatively impacts vision development. 67 However, if amblyogenic risk factors are reduced or eliminated in the early period, vision loss can be avoided thanks to the plasticity of the brain. Therefore, unilateral or bilateral cataracts detected in the neonatal period should be operated as soon as possible, refractive correction should be provided with the most appropriate CL and/or glasses immediately afterwards, and patching treatment for amblyopia should be initiated, especially in unilateral aphakia.…”

Efficacy of anti-suppression therapy in improving binocular vision in children with small-angle Esotropia

“…The vision in such children almost always improves with appropriate patching or penalization of the better eye. 3 However, evaluation of the sensory status reveals either suppression of the non-dominant eye or development of anomalous retinal correspondence (ARC). When compared to suppression, ARC is better as it allows some degree of binocular vision.…”