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Amblyopia

What's new

Updated 2023 AAO, 2019 AAFP, and 2017 USPSTF guidelines for the diagnosis and management of amblyopia.

Background

Overview

Definition
Amblyopia, often referred to as 'lazy eye,' is a neurological disease characterized by cortical visual impairment, with loss or lack of development of central vision in one eye that is unrelated to primary ocular pathology.
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Pathophysiology
Abnormal or inadequate stimulation of the visual system during its early developmental period results in amblyopia. Common etiologies include strabismus, refractive errors (anisometropia and high hyperopia), and structural ocular abnormalities (ptosis, corneal opacity, vitreous hemorrhage, and congenital cataract).
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Epidemiology
The prevalence of amblyopia in the US is estimated to be < 2,000 cases per 100,000 individuals.
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Disease course
The resulting alterations in the development of visual pathways cause clinical manifestations of visual impairment and permanent vision loss of the affected eye.
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Prognosis and risk of recurrence
Amblyopia is not associated with an increase in mortality.
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Guidelines

Key sources

The following summarized guidelines for the evaluation and management of amblyopia are prepared by our editorial team based on guidelines from the American Academy of Ophthalmology (AAO 2023), the American Academy of Family Physicians (AAFP 2019), and the U.S. Preventive Services Task Force (USPSTF 2017). ...
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Screening and diagnosis

Indications for screening: as per AAFP 2019 guidelines, obtain vision screening to detect amblyopia or its risk factors at least once between 3 and 5 years of age.
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Medical management

Cycloplegics
As per AAO 2023 guidelines:
Consider offering pharmacotherapy to produce cycloplegia of the nonamblyopic eye in patients not improving with refractive correction alone.
Consider offering atropine for pharmacologic occlusion.
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Nonpharmacologic interventions

Correction of refractive error: as per AAO 2023 guidelines, treat refractive error as the initial step in the management of 0-17 years old patients with amblyopia.

More topics in this section

  • Patching

  • Filters

  • Binocular digital therapy

Specific circumstances

Patients with cataract: as per AAO 2023 guidelines, recognize that visual deprivation amblyopia, most commonly from unilateral cataract, is difficult to treat successfully. Offer patching as first-line therapy.
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Follow-up and surveillance

Follow-up: as per AAO 2023 guidelines, schedule a follow-up examination 2-3 months after initiation of treatment in most patients, but timing will vary according to the intensity of the treatment and the age of the child.