Dx Dx Amblyopia Amblyopia WE CAN WIPE OUT AMBLYOPIA WE CAN WIPE OUT AMBLYOPIA IN OUR LIFETIMES IN OUR LIFETIMES
Transcript
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Dx Amblyopia WE CAN WIPE OUT AMBLYOPIA IN OUR LIFETIMES
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OVERVIEW Amblyopia Characteristics/TherapyAmblyopia
Characteristics/Therapy Most Clinico-Legal Problems for ODs
Infantile Esotropia-A CaseInfantile Esotropia-A Case The Infant
Examination SequenceThe Infant Examination Sequence Infantile
Esotropia CharacteristicsInfantile Esotropia Characteristics
Infantile Esotropia TherapyInfantile Esotropia Therapy The Older
EsotropeThe Older Esotrope Exotropia: Congenital &
FunctionalExotropia: Congenital & Functional
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AMBLYOPIA Caused by Anisometropia and Strabismus and what most
eye care practitioners are interested in treating Rule Out
Pathology
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Ocular and Neurologic Disease Masquerading as Functional Vision
Disorders AmblyopiaAmblyopia StrabismusStrabismus Brain Tumors:
Bitemporal Field Loss Vascular Accidents Ocular and/or Visual
Pathway Diseases
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Amblyopia Amblyopia: A Diagnosis of Exclusion. Make sure there
is no pathology first.Amblyopia: A Diagnosis of Exclusion. Make
sure there is no pathology first. Amblyopia may improve with vision
therapy even with pathologyAmblyopia may improve with vision
therapy even with pathology Always do visual fields of both eyes of
amblyopes (color and neutral density)Always do visual fields of
both eyes of amblyopes (color and neutral density) Must have 1.
Anisometropia, 2. Constant Unilateral Strabismus, 3. ^ Bilateral
RE, 4. Deprivation HxMust have 1. Anisometropia, 2. Constant
Unilateral Strabismus, 3. ^ Bilateral RE, 4. Deprivation Hx
Amblyopia Differential Dx Block-Line-Letter VA s: Better with
lettersBlock-Line-Letter VA s: Better with letters Contrast
Typically not impacted in Amblyopia Psychometric VA s: Sigmoid
CurvePsychometric VA s: Sigmoid Curve Neutral Density Filters:
Devastates VANeutral Density Filters: Devastates VA Macular
Integrity Tester: No BrushMacular Integrity Tester: No Brush
Magnification: 2.5 Telescope really improves VA beyond what is
expectedMagnification: 2.5 Telescope really improves VA beyond what
is expected Color Vision: NormalColor Vision: Normal Normal Amsler
Grid and ElectrodiagnosticsNormal Amsler Grid and
Electrodiagnostics
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Special Visual Acuity Charts Psychometric ChartPsychometric
Chart Flom Chart Cs Wesson-Davidson Chart Es Bailey-Lovie log
MARBailey-Lovie log MAR Relative = Separation High and Low Contrast
Contrast SensitivityContrast Sensitivity LEALEA B-VATB-VAT
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Amblyopia and VA Acuity improves with isolated lettersAcuity
improves with isolated letters First and last letter seen more
oftenFirst and last letter seen more often Letters read out of
orderLetters read out of order Letters change as chart is
viewedLetters change as chart is viewed Chart appears gray, dim or
poor qualityChart appears gray, dim or poor quality Refraction:
Better but I just cannot read itRefraction: Better but I just
cannot read it LARGE JNDsLARGE JNDs
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Amblyopia 2.5% of population2.5% of population A problem of
binocularityA problem of binocularity
Fixation--BinocularityFixation--Binocularity Anisometropia Constant
Unilateral Strabismus
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Amblyopia Timelines Critical Period: Birth to 6 moTreat now
Blind-NystagmusCritical Period: Birth to 6 moTreat now
Blind-Nystagmus Treat PathologyFixate with each eye Sensitive
Period: 6 mo to 8 yr. Treat Visually ImpairedSensitive Period: 6 mo
to 8 yr. Treat Visually Impaired Susceptible Period: 8 to 18
yr.Treat if compliantmay returnSusceptible Period: 8 to 18 yr.Treat
if compliantmay return Residual Plasticity Period: 18 yr.> not
likely (Lee R. Adult Amblyope: JBO 12/99 pp115- 131)Residual
Plasticity Period: 18 yr.> not likely (Lee R. Adult Amblyope:
JBO 12/99 pp115- 131)
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Amblyopia is Developmental & A BINOCULAR Dx Not just a
reduction in VA but in total visionNot just a reduction in VA but
in total vision Poor Eye MovementsPoor Eye Movements Poor
AccommodationPoor Accommodation Poor Spatio-Temporal
IntegrationTrouble judging distances and lengthsCrowdingPoor
Spatio-Temporal IntegrationTrouble judging distances and
lengthsCrowding Requires more than just patching
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Clinical Classification of Amblyopia Organic (Organic)Organic
(Organic) Form Deprivation (Structural)Form Deprivation
(Structural) Strabismus (Spatial Conflict)Strabismus (Spatial
Conflict) RefractiveRefractive Isometropic and Anisometropic
PsychogenicPsychogenic Voluntary (Malingering) Involuntary:
Hysterical and Streffs Syndrome
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Amblyopic Clinical Pearls Problems within 1st 6 months most
dangerous---Congenital Cataracts-CriticalProblems within 1st 6
months most dangerous---Congenital Cataracts-Critical Early dense
cataracts-a true critical intervention Late onset not as
severe-Sensitive-Can be amblyopic up to about 8 yearsLate onset not
as severe-Sensitive-Can be amblyopic up to about 8 years Treatment
at any time but less certain outcomes-Requires a motivated
patientTreatment at any time but less certain outcomes-Requires a
motivated patient
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Streffs Bilateral Juvenile Amblyopia Refracts: -.5 to +1D+ may
helpRefracts: -.5 to +1D+ may help VA Far: 20/25 to 20/400Walk
around +VA Far: 20/25 to 20/400Walk around + VA Near: Worse than
Far^ c +VA Near: Worse than Far^ c + Habitual RD: 10 in or
less/Peers+ moves RD outHabitual RD: 10 in or less/Peers+ moves RD
out Dynamic Ret: Dull reflexes and increased lag + improves
reflexesDynamic Ret: Dull reflexes and increased lag + improves
reflexes Fixation: Unstable central + ^ stabilityFixation: Unstable
central + ^ stability
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Streffs Bilateral Juvenile Amblyopia Pursuit: Refixations +
improvesPursuit: Refixations + improves Pen in Cap: Misses +
improvesPen in Cap: Misses + improves Yoked ^: Base preferredYoked
^: Base preferred Ball Catching: + improves timingBall Catching: +
improves timing VO Star: Poor Centration + improvesVO Star: Poor
Centration + improves History: High achiever, females, around
puberty, at exam time, holidays and springHistory: High achiever,
females, around puberty, at exam time, holidays and spring
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Streffs Syndrome in Animals
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Tx Amblyopia
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Amblyopia Efficacy of VTx.1 S ignificance at 16+ for 4 lines
Birnbaum et al. JAAO May 77
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Congenital esotropia vs. amblyopia: surgery or none Helveston,
EM. Origins of congential esotropia. J Ped Ophthalmol Strab
1993;30:215-232
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Treatment of Amblyopia Isometropic: >-5D eventual full Rx
but in steps. Consider underminus>+ 2D Temper Rx by age, amount,
in steps, keep symmetricalThink in terms of keeping 2D of hyperopia
uncorrected... Cylinder >1.25 Temper Rx as with +symmetrical and
lowalways trial framePROBE LENS TESTINGIsometropic: >-5D
eventual full Rx but in steps. Consider underminus>+ 2D Temper
Rx by age, amount, in steps, keep symmetricalThink in terms of
keeping 2D of hyperopia uncorrected... Cylinder >1.25 Temper Rx
as with +symmetrical and lowalways trial framePROBE LENS
TESTING
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Amblyopia Anisometropia: >-2D or +1D consider CL (depending
on the age and responses) Anisometropia: >-2D or +1D consider CL
(depending on the age and responses) Eventual full Rx may be much
more balancedEventual full Rx may be much more balanced MOST ANSIO
AMBLYOPIA from + > 1MOST ANSIO AMBLYOPIA from + > 1 Keep
symmetrical and spherical equivalentsKeep symmetrical and spherical
equivalents Keep Rxs Small and SimpleKeep Rxs Small and Simple
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Occlusion Full Time Direct OcclusionFull Time Direct Occlusion
1 day for each year of life and no patch the other day for the
anisometropic amblyope For the strabismic amblyope indirectly patch
the other eye for one day Partial OcclusionPartial Occlusion
Bi-Nasal Occlusion Patch for hours rather than days
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Treatment Modalities for Amblyopia Patching verses
PenalizationPatching verses Penalization Big advantage of
Penalization-it can be doneBig advantage of Penalization-it can be
done Binocularity is not destroyedBinocularity is not destroyed
PenalizationPenalization Bangerter Foils Fingernail Polish Scotch
Tape Extra Plus Meds
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Penalization FoilsFoils Colored Filters (Mono in Binocular
Field)Colored Filters (Mono in Binocular Field) Wesson MethodWesson
Method Extra PlusExtra Plus Clear Finger Nail PaintClear Finger
Nail Paint CycloplegiaCycloplegia Bi-Nasal OcclusionBi-Nasal
Occlusion Bi-Temporal OcclusionBi-Temporal Occlusion
AtropineAtropine
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Rxs for the older Amblyope and Esotrope Always try to balance
RxAlways try to balance Rx Use minimal Rx to plateau VAUse minimal
Rx to plateau VA Use minimal Rx to plateau Angle of turnUse minimal
Rx to plateau Angle of turn Hold off Rxing lenses until some VT has
been attempted (weeks)Hold off Rxing lenses until some VT has been
attempted (weeks) Plan to titrate UP + on esotropes and
anisometropesPlan to titrate UP + on esotropes and
anisometropes
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Contact Lenses and Amblyopia Knapps Law: Predicts image size
based upon length of the eye--spectacles more appropriateKnapps
Law: Predicts image size based upon length of the eye--spectacles
more appropriate Think CL even with Knapps LawThink CL even with
Knapps Law More likely to wear than odd glasses better image
quality No prismatic or Centration problems
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Amblyopia Therapy: Press Refractive AmblyopiaRefractive
Amblyopia Normally responds quicker than strabismus Passive
Suppression Binocular integration present Less occlusion time
needed Loss of resolution - little spatial distortion Knows where
and how far the target is Like looking in smoked glass or
cellophane
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Amblyopia Therapy Strabismic AmblyopiaStrabismic Amblyopia Loss
of resolution and spatial confusion Takes more time Must develop
central fixation first Active suppression Poor performance
Later Phases Tx Amblyopia Monocular Fixation in a Binocular
FieldMonocular Fixation in a Binocular Field Biocular
TherapyBiocular Therapy Binocular TherapyBinocular Therapy
Intersensory IntegrationIntersensory Integration
Monocular Therapy OculomotorOculomotor Hart Chart saccades
Michigan tracking Pointer in Straw Monocular Prism Jumps Geo
Boards, Groffman tracing AN Pointing Line Counting Perceptuomotor
Pen MIT
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Monocular therapy AccommodativeAccommodative Near Far Hart
Charts Free Space Push Up Loose Lens Rock Sequential Minus (JNDs)
Minus Lens and Marsden Ball
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Mono Tx Perceptual Discrim Hidden PicturesHidden Pictures
Similarities and DifferencesSimilarities and Differences Monocular
Contour Interaction (Back off and read letters/numbers)Monocular
Contour Interaction (Back off and read letters/numbers) Random
Count All of certain # or letters (Michigan Tracking)Random Count
All of certain # or letters (Michigan Tracking)
TachistoscopeTachistoscope Form Tracing with Crowding -Kedzia
CardForm Tracing with Crowding -Kedzia Card Visual Search
Sequential # find correct oneVisual Search Sequential # find
correct one Space Matching Distance to ChalkboardSpace Matching
Distance to Chalkboard
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Monocular Tx in Binocular Field Anaglyphic TV Trainer
(Projected Light)Anaglyphic TV Trainer (Projected Light) Sherman VT
Playing Cards (1/2 Cards)Sherman VT Playing Cards (1/2 Cards) Lens
rock with single Vectogram VA (corresponding to amblyopic eye)Lens
rock with single Vectogram VA (corresponding to amblyopic eye)
Quoits Clown/Spirangle Wayne Fixator and AnaglyphWayne Fixator and
Anaglyph Anaglyphic TracingAnaglyphic Tracing Haidinger
Brush/MITHaidinger Brush/MIT Kedzia CardsKedzia Cards
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WHY DO VT ON AMBLYOPES: If Patching gives good VA Krumholtz
& FitzGerald. Efficacy of treatment modalities in refractive
amblyopia. J AOA 1999; 70: 399-404Krumholtz & FitzGerald.
Efficacy of treatment modalities in refractive amblyopia. J AOA
1999; 70: 399-404 VAs the same with Patching &full Rx or
Patching, full Rx&VT (2 line & 20 ArcSec)VAs the same with
Patching &full Rx or Patching, full Rx&VT (2 line & 20
ArcSec) Both Patching and Patching VT group better than Optical
Correction aloneBoth Patching and Patching VT group better than
Optical Correction alone ONLY VT GROUP HAD BETTER STEREOONLY VT
GROUP HAD BETTER STEREO
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Efficacy of Tx on Amblyopia Krumholtz I, FitzGerald D. Efficacy
of treatment modalities in refractive amblyopia J am Optom Assoc
1999; 70: 399-404 Compare (6 mo) Rx; Rx & Patch; Rx/VT
N=78Compare (6 mo) Rx; Rx & Patch; Rx/VT N=78 2 Line and 20 sec
increase; the criterion2 Line and 20 sec increase; the criterion
Patch and VT have similar VAsPatch and VT have similar VAs VT shows
significantly greater stereoVT shows significantly greater stereo
Conclusion:Patching aloneimprovement of visual acuity, binocular
performance is significantly better when vision therapy is included
in the treatment regimen.Conclusion:Patching aloneimprovement of
visual acuity, binocular performance is significantly better when
vision therapy is included in the treatment regimen.
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FitzGerald: Amblyopia Krumholtz I, FitzGerald D. Efficacy of
treatment modalities in refractive amblyopia. J Am Optom Assoc
1999;70:399-404 Amblyopia from Refractive (Aniso)Amblyopia from
Refractive (Aniso) 2 lines & 20arcsec Improvement2 lines &
20arcsec Improvement TxTx Do Nothing Rx Rx + Patch and Eye Hand Rx
+ Patch and Eye Hand and VTx RetrospectiveRetrospective 4 to 6
weeks after 2 to 4 months 6 months to 12 months Note in all Tx:
Some make dramatic improvement and some never move Patch and VTx
are the Same for Amblyopia TxPatch and VTx are the Same for
Amblyopia Tx Rx alone was not as effectiveRx alone was not as
effective
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FitzGerald: Amblyopia VA &Stereo Krumholtz I, FitzGerald D.
Efficacy of treatment modalities in refractive amblyopia. J Am
Optom Assoc 1999;70:399-404 & S Optical Correction Alone 41% VA
and 18% StereoOptical Correction Alone 41% VA and 18% Stereo
Optical Correction and Patch 69% VA and 30% StereoOptical
Correction and Patch 69% VA and 30% Stereo Optical Correction;
Patch and VTx 67% and 67%Optical Correction; Patch and VTx 67% and
67%
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FitzGerald: % Improvement Refractive Amblyopia VA & Stereo
Krumholtz I, FitzGerald D. Efficacy of treatment modalities in
refractive amblyopia. J Am Optom Assoc 1999;70:399-404
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FitzGerald: Refractive Amblyopia FitzGerald DE, Krumholtz I.
Maintenance of improvement gains in refractive amblyopia: a
comparison of treatment modalities. Optometry 2002; 73: 153-9.
Maintenance of Visual Acuity Gains over Time (From 1 to 2
years)Maintenance of Visual Acuity Gains over Time (From 1 to 2
years) Optical Correction 50% Optical Correction & Patching
with Eye Hand Activities 60% Optical Correction & Patching with
Eye Hand Activities and Vision Therapy 100% 94% of those who
maintained their VAs maintained their stereo
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FitzGerald: Refractive Amblyopia FitzGerald DE, Krumholtz I.
Maintenance of improvement gains in refractive amblyopia: a
comparison of treatment modalities. Optometry 2002; 73: 153-9.
Maintenance of Gains Amblyopia FitzGerald DE, Krumholtz I.
Maintenance of improvement gains in refractive amblyopia:Optometry
2002; 73: 153-9. Records of 6 month study retrospectively at 1 to 2
years to see if gains are holdingRecords of 6 month study
retrospectively at 1 to 2 years to see if gains are holding Holding
Gains: N=23Holding Gains: N=23 50% with Rx 60% with Rx and Patching
100% with Rx and VT Oldest age held the bestOldest age held the
best
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VA Gains over Time for Amblyopia (of those improved) FitzGerald
& Krumholtz 2002
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VA Gains over Time for Amblyopia (of those improved)
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Amblyopia Tx and Compliance (N=52) 3 mo Occlusion, previous
failure in VA improvement MinsAmblyopia Moo & Ko.Proc 8
Japan-Korea Ophthal 1996
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Summary: Amblyopia Tx Consider a modified RxConsider a modified
Rx Consider some type of Patching/PenalizationConsider some type of
Patching/Penalization Central and Stable FixationCentral and Stable
Fixation Central Fixation and Monocular Tx Equality between
eyesEquality between eyes Monocular Tx Monocular training in a
binocular fieldMonocular training in a binocular field Biocular Tx
Suppression TherapySuppression Therapy Biocular Tx Binocular
integrationBinocular integration Binocular Therapy
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Infantile Esotropia
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1st Case: Subjective 19 mo White Female19 mo White Female
Esotropia from 6 monthsEsotropia from 6 months Full Term Pregnancy:
No problems with pregnancy or birth-First ChildFull Term Pregnancy:
No problems with pregnancy or birth-First Child Crawled at 6
monthsCrawled at 6 months Walked at 10 monthsWalked at 10 months
Threw tantrums and wanted things her way when tiredThrew tantrums
and wanted things her way when tired
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1st Case: Subjective Continued O-MD exam at 6 monthsO-MD exam
at 6 months Healthy EyesHealthy Eyes Congenital EsotropiaCongenital
Esotropia Cycloplegic Rx dispensed (+2.25D sph OU) and told to
return in 6 months if not straight surgery would be
suggestedCycloplegic Rx dispensed (+2.25D sph OU) and told to
return in 6 months if not straight surgery would be suggested
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1st Case: Objective Hyperactive ChildHyperactive Child Present
RX +2.25Present RX +2.25 Retinoscope at far +1.50Retinoscope at far
+1.50 EOMs full--OS less accurateEOMs full--OS less accurate Head
MovementHead Movement Uncoordinated Visual Motor Patterns
(Body)Uncoordinated Visual Motor Patterns (Body) Eyes HealthyEyes
Healthy
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1st Case: Assessment Infantile Esotropia OS with Hyperopia
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1st Case: Plan LensesLenses Home Vision TherapyHome Vision
Therapy 2/week Later 1/week as a progress examinationLater 1/week
as a progress examination
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1st Case: Education No GuaranteesNo Guarantees Goal:Goal:
Straight Eyes Diminish the Rx if Possible
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1st Case: Initial Tx Periodic Patching (short periods of
time-more OD than OS)Periodic Patching (short periods of time-more
OD than OS) Movement Patterns of Head, Neck and BodyMovement
Patterns of Head, Neck and Body Prone Neck Rotations Dry Land
Swimming Crawling Bright Objects---Cross Patterning--VT depends on
motivation (Time at Task)Bright Objects---Cross Patterning--VT
depends on motivation (Time at Task) Sleep Patterns
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1st Case: Early Progress Exams 2 Weeks: Change Rx to +1.50 c
+0.75 add2 Weeks: Change Rx to +1.50 c +0.75 add Mother reports
eyes are straighter 6 Weeks: Change +1.50D with Bi-Nasals6 Weeks:
Change +1.50D with Bi-Nasals Mother reports steady improvement of
eyes-eyes are straighter longer 9 Weeks: Change Rx to +0.75 c +0.75
Add9 Weeks: Change Rx to +0.75 c +0.75 Add 14 Week: Change Rx to
+0.75 and released without bi- nasal occlusion14 Week: Change Rx to
+0.75 and released without bi- nasal occlusion
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1st Case: Later Progress Exams 1 month post release:1 month
post release: Goes without lenses Eye does not turn normally Turns
if tired or excitedTurns if tired or excited 3 months post
release:3 months post release: Eyes seldom turn Seldom wears
Rx
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Long Term Follow Up All State BasketballAll State Basketball
All State TennisAll State Tennis Full scholarship Southern Miss:
TennisFull scholarship Southern Miss: Tennis Real Estate
Agent/Broker Gulfport/WigginsReal Estate Agent/Broker
Gulfport/Wiggins 34 years of Age34 years of Age Mother of 2Mother
of 2
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Strabismus Infantile-(within 6 months of age) 1-2% of
populationInfantile-(within 6 months of age) 1-2% of population
Accommodative esotropia (typically 2 to 3 years) seen in 2-2.5% of
populationAccommodative esotropia (typically 2 to 3 years) seen in
2-2.5% of population Most common-Pseudo-esotropia--Most
common-Pseudo-esotropia-- Provide ReassuranceProvide Reassurance It
is good to photo-document the Pseudo-esotropia (Epicanthal Folds)It
is good to photo-document the Pseudo-esotropia (Epicanthal
Folds)
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Tropia at Birth Hainline etal Chap 15 Simon Early Visual
Development Normal and Abnormal Oxford Press 1993
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Visual Acuities Follows light and or bright objectFollows light
and or bright object Will reach for a candy beadWill reach for a
candy bead Optokinetic Nystagmus-Temporal/NasalOptokinetic
Nystagmus-Temporal/Nasal Preferential LookingPreferential Looking
Cereal CardCereal Card Broken WheelBroken Wheel LeaLea
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Pathologies PUPILS and MOTILITIESPUPILS and MOTILITIES Around
the eyeAround the eye Anterior SegmentAnterior Segment Posterior
SegmentPosterior Segment Ophthalmoscopy should always be
last!Ophthalmoscopy should always be last!
Lens Prescription: Very ConservativeVery Conservative Develop
Fixation in Each Eye for Anisometropia, Amblyopia and
EmmetropizationDevelop Fixation in Each Eye for Anisometropia,
Amblyopia and Emmetropization Prescribe Equal Minimal
SpheresPrescribe Equal Minimal Spheres Titrate Up or Down the Rx
Bi-MonthlyTitrate Up or Down the Rx Bi-Monthly WHEN IN DOUBT, ASK
FOR HELP FROM YOUR PEDIATRIC O. D.WHEN IN DOUBT, ASK FOR HELP FROM
YOUR PEDIATRIC O. D. Smith et al. UH Refractive Errors
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Ocular Motilities Parent Moves BabyParent Moves Baby
Horizontal, Down, Up, Rotational Bright ObjectBright Object Black
and White Early in Life-Later Colors Noisy Object Noisy Object
Bright and Noisy ObjectBright and Noisy Object Broad HBroad H
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Binocularity No child is binocular at birthNo child is
binocular at birth ???Congenital Esotropia??????Congenital
Esotropia??? Convergence indicates both Cortical Fusion and
StereopsisConvergence indicates both Cortical Fusion and Stereopsis
Critical Periods???Maybe not as Critical???Critical Periods???Maybe
not as Critical???
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Must Reading Helveston E. 19th Annual Costenbader Lecture on
Congenital Esotropia. J Ped Opthtalmol Strab 1993 215-232.Helveston
E. 19th Annual Costenbader Lecture on Congenital Esotropia. J Ped
Opthtalmol Strab 1993 215-232. Thorn F, et.al. The development of
alignment, convergence and sensory binocularity. Invest Ophthalmol
Vis Sci 1994 544-553.Thorn F, et.al. The development of alignment,
convergence and sensory binocularity. Invest Ophthalmol Vis Sci
1994 544-553.
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Developmental Milestones Ocular Motilities Present at 12
weeksOcular Motilities Present at 12 weeks Visual MotorVisual Motor
Eye-Hand Coordination Denver Developmental ScreeningDenver
Developmental Screening Developmental Clusters Gross MotorGross
Motor Fine MotorFine Motor SocialSocial LanguageLanguage
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Visual Expecteds At 6 Months VA 20/80 to 20/200VA 20/80 to
20/200 Retinoscopy: Pl to +1.25 Highly VariableRetinoscopy: Pl to
+1.25 Highly Variable Pupils Normal and ReactivePupils Normal and
Reactive Alignment AlwaysAlignment Always Follows Moving Target in
Sitting PositionFollows Moving Target in Sitting Position NPC to
the NoseNPC to the Nose No Internal or External PathologiesNo
Internal or External Pathologies
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Conclusions Assure that Child is Developing CorrectlyAssure
that Child is Developing Correctly No PathologyNo Pathology No
Amblyopic PredispositionsNo Amblyopic Predispositions No High
Refractive SituationsNo High Refractive Situations No Abnormal
Binocular DevelopmentsNo Abnormal Binocular Developments No
Abnormal Ocular Motor FunctionsNo Abnormal Ocular Motor Functions
WHEN IN DOUBT, CALL A FRIEND YOUR PEDIATRIC OPTOMETRISTWHEN IN
DOUBT, CALL A FRIEND YOUR PEDIATRIC OPTOMETRIST
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Esotropia & Child Development What is normal at birth?
AndWhat is normal at birth? And What should one expect as the child
grows and matures? AndWhat should one expect as the child grows and
matures? And What should be done if one sees that the child is not
growing/maturing as it should?What should be done if one sees that
the child is not growing/maturing as it should?
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Esotropia: Characteristics Esotropia: Characteristics A high
incidence in the first yearA high incidence in the first year An
increase in incidence in the 2 to 3 year rangeAn increase in
incidence in the 2 to 3 year range great majority of esotropia is
present by school agegreat majority of esotropia is present by
school age Esotropia presenting after school age is very likely to
be non-functionalEsotropia presenting after school age is very
likely to be non-functional
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Incidence of Esotropia: Keiner
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Prevalence of Esotropia: Keiner
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Prevalence of Esotropia: Scobee
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Incidence of Infantile Esotropia by Correlation Wt