AMBLIOPIA

Sakinah Ginna R
Rizkiani Juleshodia W
 DEFINISI
Penurunan tajam penglihatan dengan
koreksi terbaik unilateral atau bilateral
yang bukan disebabkan secara langsung
oleh berbagai kelainan struktur bola mata
atau adanya gangguan jalur penglihatan
posterior.
 Prevalence:
Prevalence: 2%-4%
2%-4% in
in the
the North
North American
American
population
population
Commonly
Commonly unilateral
unilateral
Nearly
Nearly allall amblyopic
amblyopic visual
visual lossloss is
is
preventable
preventable or or reversible
reversible with
with timely
timely
detection
detection and
and appropriate
appropriate intervention.
intervention.
Children
Children with
with amblyopia
amblyopia or or atat risk
risk for
for
amblyopia
amblyopia should
should be be identified
identified at
at aa young
young
age
age when
when the the prognosis
prognosis forfor successful
successful
treatment
treatment is
is best.
best.
Role
Role of
of screening
screening is is important
important 3
 ETIOLOGI
Kurangnya rangsangan untuk
meningkatkan perkembangan penglihatan
makula, antara lain akibat :
Strabismus
Katarak
Kelainan refraksi unilateral atau bilateral yang
tidak dikoreksi
 ETIOLOGI
Nirpakai (non use)
Terjadi akibat tidak dipergunakannya elemen
visual retino kortikal pada saat kritis
perkembangannya (t.u. sebelum 9 tahun)
Supresi

Di bawah penglihatan binokular, bayangan

yang terlihat di salah satu mata menjadi
predominan dan yang terlihat di mata yang
lain tidak dipersepsikan.
6
7
8
 MANIFESTASI KLINIK
Berkurangnya penglihatan satu mata
Menurunnya tajam penglihatan terutama pada
fenomena crowding
Hilangnya sensitivitas kornea
Mata mudah mengalami fiksasi eksentrik
Adanya anisokoria
Tidak mempengaruhi penglihatan warna
Biasanya daya akomodasi menurun
Tidak terdapat kelainan organik pada retina
maupun korteks serebri
 KLASIFIKASI
Ambliopia fungsional
Ambliopia strabismik
Ambliopia refraktif
Ambliopia anisometropik
Ambliopia ametropik
Ambliopia eks anopsia
Ambliopia intoksikasi
Ambliopia histeria
Ambliopia organik
 Ambliopia strabismus
Terjadiakibat juling lama (terjadi supresi
pada mata u mencegah diplopia)
Kedudukan bola mata tidak sejajar
hanya satu mata yang diarahkan pada
benda yang dilihat.
Ditemukan pada penderita esotropia,
jarang pada eksotropia.
 Ambliopia refraktif
Ametropia yang tidak dikoreksi,
Anisometropia yang tidak dikoreksi,
Isoametropia :
Hipermetropia dalam,
Miopia berat
Astigmatik
 Mild
Mild hyperopic
hyperopic or
or astigmatic
astigmatic anisometropia
anisometropia
(1-2D)
(1-2D) mild
mild amblyopia
amblyopia
Mild
Mild myopia
myopia anisometropia
anisometropia (less
(less than
than -3D)
-3D)
usually
usually doesn't
doesn't cause
cause amblyopia
amblyopia
unilateral
unilateral high
high myopia
myopia (-6D)
(-6D) sever
sever
amblyopia
amblyopia visual
visual loss.
loss.
The
The eye
eye ss of
of aa child
child with
with anisometropic
anisometropic
amblyopia
amblyopia look
look normaly
normaly toto the
the family
family and
and
primary
primary care
care physician.
physician.
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15
 Ambliopia anisometrik
Anisometropia bayangan benda
pada kedua mata tidak sama besar
mata memfokuskan melihat dengan
satu mata.
Bayangan yang lebih suram akan
disupresi (mata yang lebih ametropik)
 Ambliopia ametropia
Menurunnya tajam penglihatan mata
dengan kelainan refraksi berat yang tidak
dikoreksi :
Hipermetropia tinggi (+ 7,0 D)
Astigmat (3,0 D)
 Ambliopia eks anopsia
Akibat penglihatan terganggu pada saat
perkembangan penglihatan bayi.
Dapat terjadi pada katarak kongenital,
ptosis, atau kekeruhan kornea sejak lahir
yang terlambat diatasi.
 In
In children
children younger
younger than
than 66 years,
years, dons
dons
congenital
congenital cataract
cataract that
that occupy
occupy the
the central
central 33
mm.
mm. or
or more
more ofof the
the lens
lens must
must be
be considered
considered
capable
capable of
of causing
causing sever
sever amblyopia
amblyopia..
Similar
Similar lens
lens opacities
opacities acquired
acquired after
after 66 years
years
are
are generally
generally less
less harmful.
harmful.

19
20
 Ambliopia intoksikasi
Penyebab : alkohol, tembakau, timah dan
bahan toksik lainnya

Neuritis optik
 Ambliopia histeria
Terjadiakibat adanya histeria yang dapat
mengenai satu mata, akan tetapi lebih
sering mengenai kedua mata.
Pemeriksaan fisik:
Lapangan pandang menciut konsentris
Blefarospame
Memejamkan mata
Lakrimasi
 Ambliopia organik
Reversibel
Misalnya: ambliopia akibat kerusakan
fovea kongenital.
 PEMERIKSAAN
Uji crowding phenomena
mengetahui adanya ambliopia
Uji densiti filter netral

mengetahui adanya ambliopia

Uji Worths Four Dot

fusi & penglihatan stereosis

Visuskop
 E O

Crowding
Crowding bar,
bar, or
or contour
contour interaction
interaction bars,
bars, allow
allow the
the
examinator
examinator to to test
test the
the crowding
crowding phenomenon
phenomenon withwith
isolated
isolated optotype.
optotype. Bar Bar surrounding
surrounding thethe optotype
optotype
mimic
mimic the
the full
full of
of optotype
optotype to
to the
the amblyopia
amblyopia child.
child.
25
 Treatment

Treatment
Treatment of
of amblyopia
amblyopia involves
involves the
the
following
following steps:
steps:
Eliminating
Eliminating (if(if possible)
possible) any
any obstacle
obstacle to
to
vision
vision such
such asas aa cataract
cataract
Correcting
Correcting refractive
refractive error
error
Forcing
Forcing use
use ofof the
the poorer
poorer eye
eye by
by limiting
limiting use
use
of
of the
the better
better eye.
eye.

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 Cataract removal
Cataracts
Cataracts capable
capable of of producing
producing amblyopia
amblyopia require
require
surgery
surgery without
without unnecessary
unnecessary delay.
delay.
Removal
Removal of of significant
significant congenital
congenital lens lens opacities
opacities
during
during the
the first
first 2-3
2-3 months
months of of life
life is
is necessary
necessary for
for
optimal
optimal recovery
recovery of of vision.
vision.
In
In symmetrical
symmetrical bilateral
bilateral cases,
cases, thethe interval
interval between
between
operations
operations on on the
the first
first and
and second
second eyeseyes should
should be
be no
no
more
more than
than 1-21-2 weeks.
weeks.
Acutely
Acutely developing
developing severe
severe traumatic
traumatic cataracts
cataracts inin
children
children younger
younger thanthan 66 years
years should
should be be removed
removed
within
within aa few
few weeks
weeks of of injury,
injury, ifif possible.
possible. 27
 Refractive correction

In
In generally,
generally, optical
optical prescription
prescription for
for
amblyopic
amblyopic eyes
eyes should
should correct
correct the
the full
full
refractive
refractive error
error asas determined
determined withwith
cyclopagic.
cyclopagic.

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 Occlusion and optical degradation
Full
Full time
time occlusion
occlusion of
of the
the sound
sound eye:
eye:
Defined
Defined as
as occlusion
occlusion for
for all
all or
or all
all but
but one
one waking
waking
hour.
hour.
It
It is
is the
the most
most powerful
powerful means
means of of treating
treating ofof
amblyopia
amblyopia byby enforced
enforced use
use of
of the
the defective
defective eye.
eye.
The
The patch
patch can
can either
either be
be left
left in
in place
place at
at night
night or
or
removed
removed atat bedtime.
bedtime.
Spectacle-mounted
Spectacle-mounted occluser
occluser or or special
special opaque
opaque
contact
contact lenses
lenses can
can be
be used
used asas an
an alternative
alternative to
to full-
full-
time
time patching
patching ifif skin
skin irritation
irritation or or poor
poor adhesion
adhesion
proves
proves to
to be
be aa significant
significant problem
problem
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30
31
 Full
Full time
time patching
patching should
should generally
generally be
be used
used
only
only when
when constant
constant strabismus
strabismus eliminates
eliminates
any
any possibility
possibility of
of useful
useful binocular
binocular vision
vision
because
because full
full time
time patching
patching runs
runs aa small
small
risk
risk of
of perturbing
perturbing binocularity.
binocularity.

32
Part-time occlusion:
Defined
Defined as
as occlusion
occlusion for
for 1-6
1-6 hours
hours per
per day.
day.
The
The children
children undergoing
undergoing partpart time
time occlusion
occlusion
should
should be
be kept
kept as
as visually
visually active
active as
as possible
possible
when
when the
the patch
patch is
is in
in place.
place.
Compliance
Compliance withwith occlusion
occlusion therapy
therapy for
for
amblyopia
amblyopia declines
declines with
with increasing
increasing age.
age.

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Penalization:
A
A cyclopagic
cyclopagic agent
agent (usually
(usually atropine
atropine 1%1% oror
homatropine
homatropine 5% 5% )) once
once daily
daily to
to the
the better
better
eye
eye
This
This form
form ofof treatment
treatment has
has recently
recently been
been
demonstrated
demonstrated to to be
be as
as effective
effective asas patching
patching
for
for mild
mild to
to moderate
moderate amblyopia.
amblyopia.

34
 Complication of therapy
Full
Full time
time occlusion
occlusion carries
carries thethe greatest
greatest risk
risk of
of this
this
complication
complication and and requires
requires close close monitoring,
monitoring,
especially
especially inin the
the younger
younger child.
child.
The
The first
first follow
follow up up visit
visit after
after initial
initial treatment
treatment
should
should occur
occur within
within 11 week
week for for an
an infant
infant and
and after
after
interval
interval corresponding
corresponding to to 11 week
week per
per year
year ofof age
age for
for
the
the older
older child.
child.
Part
Part time
time occlusion
occlusion & & optical
optical degradation
degradation methods
methods
allow
allow forfor less
less frequent
frequent observation
observation but but regular
regular
follow
follow upup is
is still
still critical
critical
35
 The
The time
time required
required for
for completion
completion of
of
treatment
treatment depends
depends on
on the
the following:
following:
1.
1. Degree
Degree of of amblyopia
amblyopia
2.
2. Choice
Choice ofof therapeutic
therapeutic approach
approach
3.
3. Compliance
Compliance withwith the
the prescribed
prescribed regimen
regimen
4.
4. age
age of
of the
the patient
patient

36
 Unresponsiveness
Complete
Complete or
or partial
partial Unresponsiveness
Unresponsiveness to to treatment
treatment
occasionally
occasionally affect
affect younger
younger children
children but
but must
must often
often
occurs
occurs inin patients
patients older
older than
than 55 years.
years.
Primary
Primary therapy
therapy should
should generally
generally be
be terminated
terminated ifif
there
there is
is aa lock
lock of
of demonstrable
demonstrable progress
progress over
over 3-6
3-6
months
months with
with good
good compliance.
compliance.
Refraction
Refraction should
should be
be carefully
carefully rechecked
rechecked and and the
the
macula
macula and and optic
optic nerve
nerve critically
critically inspected
inspected forfor
subtle
subtle evidence
evidence ofof hypoplasia
hypoplasia oror other
other malformation
malformation
that
that might
might have
have been
been previously
previously overlooked.
overlooked.

37
 Recurrence
When
When amblyopia
amblyopia treatment
treatment is
is discontinued
discontinued after
after fully
fully
or
or partially
partially successful
successful completion,
completion, approximately
approximately halfhalf
of
of patients
patients show
show some
some dgree
dgree of
of recurrence,
recurrence,
Maintenance
Maintenance therapy:
therapy:
Patching
Patching for
for 1-3
1-3 hours
hours per
per day
day
Optical
Optical penalization
penalization with
with spectacles
spectacles
Pharmacologic
Pharmacologic penalization
penalization with
with atropine
atropine 11 or
or 22 day
day
per
per week.
week.
This
This may
may require
require periodic
periodic monitoring
monitoring until
until age
age 8-10.
8-10.
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