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Unlike many other ocular sight-threatening conditions, amblyopia is both preventable and treatable—if caught early. The Pediatric Eye Disease Investigator Group (PEDIG) has provided extensive evidence for the efficacy of treatment, but it’s not always straightforward. On Wednesday, October 21,  1-2pm, Timothy Hug, OD, will provide his audience a roadmap for treating amblyopia, including a close look at the disease process and the most recent findings.

What’s Missing in the Amblyopic Eye?

  • Increased sensitivity to contour interaction effects
  • Abnormal spatial distortions and uncertainty
  • Unsteady and inaccurate monocular fixation
  • Poor eye tracking ability
  • Reduced contrast sensitivity
  • Inaccurate accommodative response

Amblyopia that manifests within the first three years can be the most difficult to treat, as some research shows the ocular system is maturing by the ages of four to seven. Less plasticity remains as we get older through the ages of eight to 10, Dr. Hug says. It’s no surprise then, that the PEDIG trials show reduced treatment effect for kids between the ages of seven and 12 compared with those treated when they were between three and seven.

Nevertheless, some children still respond to treatment at an older age, and some maintain visual improvement while others regress, Dr. Hug admits. It’s all about strategizing the right treatment path for each case, he says. It’s not always cut-and-dry.

Dr. Hug will help attendees become familiar with the management course for amblyopia. If done right, you could save the patient's vision.
Dr. Hug will help attendees become familiar with the management course for amblyopia. If done right, you could save the patient's vision. 

Strategies for Treatment Success

  • Choose an evidence based treatment
  • Consider age of patient AND Duration of insult
  • Plan for close monitoring
  • Plan for poor compliance
  • Plan for increasing intensity of treatment
  • Plan for maintenance
  • Plan for regression

Treatment Pearls

Much of the session will center on the types of treatment available, including refraction, occlusion, atropine and even iPad therapy. PEDIG recommends a step-wise approach, and Dr. Hug will walk his audience through when to prescribe spectacle correction, patching, weekend atropine and Bangerter filters, and when it’s time to ramp up therapy and taper.

Regression is bound to happen, Dr. Hug says, which is why follow-ups are crucial. Maintenance therapy is a whole other aspect of amblyopia care, and Dr. Hug will answer key questions about how amblyogenic factors arise, whether they remain and if maintenance is necessary for the duration of the amblyogenic timeframe.

Because amblyopia is a pediatric condition, clinicians have to be prepared for a few uphill battles, Dr. Hug warns. Amblyopia requires close monitoring, increasing treatment intensity and maintenance therapy, all of which can make patient/parent compliance tough. But Dr. Hug has some tricks up his sleeve that he will share with attendees.

A few case examples will drive home the session’s main points. By the talk’s end, viewers will be able to confidently recommend the best treatment strategy for a pre-verbal 18-month-old, a three-year-old with a posterior polar cataract to blame and a child first diagnosed with amblyopia at the age of nine.