eMedicine Specialties > Ophthalmology > Neurologic Disorders

Amblyopia: Follow-up

Author: Kimberly G Yen, MD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine
Contributor Information and Disclosures

Updated: Dec 31, 2008

Follow-up

Further Outpatient Care

  • Outpatient follow-up care needs to continue beyond the primary completion of amblyopia treatment because visual deterioration occurs in many children. In a multicenter study conducted as part of the Amblyopia Treatment Studies, one fourth of patients experienced recurrence of amblyopia within the first year after treatment, with the risk of recurrence greater if the treatment was stopped abruptly rather than tapered. One study by Levartovsky et al showed deterioration in 75% of children with anisometropia of 1.75 diopters or more after occlusion therapy.24  Recidivism can occur, even several years after the initial treatment period, and is as high as 53% after 3 years.

Deterrence/Prevention

  • Vision screening programs: Studies have shown these programs to be technically easy and that they help reduce cost as well as incidence of amblyopia because of early treatment and detection. Current programs include use of the photorefractor and school vision screening programs.
  • Amblyopia after trauma
    • Young patients who have trauma to their eyes often are at risk for occlusion amblyopia. Possible reasons include lid edema, hyphema, occlusive dressing, vitreous hemorrhage, and traumatic cataract.
    • This amblyopia often is superimposed on a visual deficit caused by any structural abnormality and needs to be taken into account when treating these children.
    • Vision needs to be monitored closely in children after ocular trauma, especially in those aged up to 6 years and in nonverbal children. Occlusive therapy needs to be instituted if there is any suggestion of decreased vision in the injured eye.

Complications

  • The main complication of not treating amblyopia is long-term irreversible vision loss. Most cases of amblyopia are reversible if detected and treated early, so this vision loss is preventable.

Prognosis

  • After 1 year, about 73% of patients show success after their first trial of occlusion therapy. Studies have shown that the number of patients who retain their level of visual acuity decreases over time to 53% after 3 years.
  • Risk factors for failure in amblyopia treatment include the following:
    • Type of amblyopia: Patients with high anisometropia and patients with organic pathology have the worse prognosis. Patients with strabismic amblyopia have the best outcome.
    • Age at which therapy began: Younger patients seem to do better.
    • Depth of amblyopia at start of therapy: The better the initial visual acuity in the amblyopic eye, the better the prognosis.

Patient Education

  • Parents need to be educated about the importance of treatment and compliance as well as the visual implications because the treatment of amblyopia often lies in the hands of the parents.
  • For excellent patient education resources, visit eMedicine's Eye and Vision Center. Also, see eMedicine's patient education article How to Instill Your Eyedrops.

Miscellaneous

Medicolegal Pitfalls

  • The clinician must educate parents and patients of the implications of not treating amblyopia. A delay in treatment beyond the critical period results in irreversibility of amblyopia and could result in liability claims against the physician.

Special Concerns

  • Early treatment and detection is the key to visual rehabilitation in amblyopic patients. Methods of identifying children at risk or who have amblyopia are needed. Further research into the mechanism of amblyopia is needed to be able to address and treat the direct etiology.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the assistance of Ryan I Huffman, MD, with the literature review and referencing for this article.



More on Amblyopia

Overview: Amblyopia
Differential Diagnoses & Workup: Amblyopia
Treatment & Medication: Amblyopia
Follow-up: Amblyopia
References
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References

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Further Reading

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Keywords

amblyopia, lazy eye, functional amblyopia, organic amblyopia, decreased vision, poor visual acuity, vision loss, monocular vision loss, blindness in one eye, strabismus, strabismic anisometropia, anisometropia, amblyopia treatment studies, ATS, refractive error, occlusion therapy, patching

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Contributor Information and Disclosures

Author

Kimberly G Yen, MD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine
Kimberly G Yen, MD is a member of the following medical societies: Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Gerhard W Cibis, MD, Clinical Professor, Director of Pediatric Ophthalmology Service, Department of Ophthalmology, University of Kansas, Kansas City
Gerhard W Cibis, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, and American Ophthalmological Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

J James Rowsey, MD, Former Director of Corneal Services, St Luke's Cataract and Laser Institute, Florida
J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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