DIFFICULT AMBLYOPIA

"Difficult" amblyopia is where the vision in the bad eye is particularly bad (say, count fingers) or not good enough to function well in a classroom (say, 6/30), or where other pathology is present such that compliance with occlusion is likely to be difficult and the visual improvement likely to be uncertain. This is the amblyopia where the benefit one anticipates for the amount of work to be put in is low, or where one expects the progress to be painfully slow and difficult for everyone concerned, or where one knows that the child will be reduced to functionally "blind" status for at least a few days once occlusion is initiated.

Parents have to be careful, thoughtful and plan this as one might plan any other serious medical treatment.

What parents must do is ensure in advance that the child will be adequately entertained (lots of video games, computer games, books to read to the child, games for the child to play…) and the child's safety is ensured (do not let the child go outside without supervision, do not let the child ride a bicycle without you holding the bicycle, do not let the child climb or play on playground equipment without you being right next to the child,…).

Improvement in visual function is very encouraging and allows us to continue with the above difficult treatment.

Traditionally when one measures improvement in vision, one looks at fixation patterns or one measures one particular acuity chart (the Lea Chart is highly recommended).

With difficult amblyopia I use many different parameters including single letters, single numbers, Melbourne Edge Test, gratings and potential acuity tests. Sometimes improvements are only seen in one or two of these parameters. Sometimes "L-Dopa" solution is used to (hopefully) improve the response

UPDATE:

The use of L-Dopa for stubborn ambloypia in children aged 8-17 has recently been studied.

The results are not out at the time of writing this note (June 2010) but are due within the next few wekks or months.

As soon as the data becomes available a summary will be posted at the spot.