Amblyopia Follow-up

Updated: Apr 05, 2016
  • Author: Kimberly G Yen, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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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. [31] Recidivism can occur, even several years after the initial treatment period, and is as high as 53% after 3 years.

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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.

Longmuir et al reported the results of a 9-year, volunteer photoscreening program. [32] From 2000-2009, 147,809 children underwent photoscreening to detect amblyopic risk factors; 6247 children (4.2%) were referred to local eye care professionals. Of the children referred, 24.3% were evaluated by local ophthalmologists and 76.7% were seen by local optometrists. The follow-up rate ranged from 36.1-89.5%, with an overall program follow-up rate after the addition of a follow-up coordinator of 81.3%. Including the overall operational budget, the cost of screening was reduced to $9 per child. Although the Medical Technology and Innovations (MTI) photoscreener used in this program is no longer manufactured, this report does illustrate that cost-effective screening can be done using a volunteer system and demonstrates the problem of successful screening that is not followed with a visit to an eye care professional.

Conclusions

The addition of a part-time follow-up coordinator to the photoscreening program produced 89.5% follow-up rate when screening 147 809 children for amblyopia risk factors over a 9-year period.

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, corneal opacity or irregularity, 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.

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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.

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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.

A study by Mirabella et al determined that even with successful treatment of an amblyopic eye, perception of images in real-world scenes remains altered in patients with a history of amblyopia. [33]

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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 eMedicineHealth's Eye and Vision Center. Also, see eMedicineHealth's patient education article How to Instill Your Eyedrops.

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