Amblyopia treatment methods

To eliminate inhibition, improve visual acuity, correct eye position, train macular fixation and fusion function, in order to restore the visual function of both eyes. 1.Optical correction Almost all patients with amblyopia have combined refractive error, and the direct cause of amblyopia in refractive amblyopia and refractive parallax amblyopia is refractive error. The presence of refractive error can lead to blurred retinal imaging or suppression of the healthy eye. Therefore, optical lenses, contact lenses, or refractive surgery are used to first clarify the retinal image of the amblyopic eye and lay the imaging foundation for visual development. The prerequisite for optical correction is accurate optometry. Patients with amblyopia are required to obtain a static, accurate optometric result by paralyzing the eye’s accommodation with a dilating agent. Then, based on the patient’s refractive error data obtained from the dilated eye exam and the different types of refractive errors, fitting data is obtained by trial lenses after pupil retraction. For all patients with amblyopia, who are clearly examined for refractive error, it is necessary to keep the glasses on constantly and not to take them off and on to ensure good eye adaptation to the lenses and a stable optical correction. The pupil should be dilated with 1% atropine eye drops or eye ointment, and the fundus should be checked for lesions before a detailed optometry is done to determine the degree of refractive error, and those with hyperopia or hyperopic astigmatism should be given glasses for correction. Many strabismus wear glasses for a period of time, the eyes are not slanted, or the strabismus degree is significantly reduced. For such a child, we should encourage him to insist on wearing glasses, look far and near to wear, not to interrupt, generally insist on wearing about half a year to see the effect. After wearing the glasses should be every 1 year optometry 1, in order to grow with the age, adjust the glasses degree. 2. Covering Covering and optical correction are called the cornerstones of amblyopia treatment methods. Especially for amblyopic patients with inconsistent amblyopia in both eyes, the scientific nature of the masking program and the degree of implementation play an absolute role in the effectiveness of amblyopia treatment. The most common method of masking is to cover the healthy eye (the one with better vision). With the masking and visual deprivation of the healthy eye, the poor eye is able to gain visual perception and visual afferent opportunities, thus the poor eye is exercised and excited. Masking needs to be combined with the condition and age. For example, for amblyopes younger than 3 years old, it is generally not recommended to cover more than 6 hours per day in one eye, and monitoring of visual acuity in the healthy eye is needed to prevent masking amblyopia. In cases where the amblyopia is close in both eyes, alternate masking is sometimes used. This means that the two eyes are covered alternately, so that the open eye is given alternate opportunities for visual exercise. In cases where strabismus is present, alternate masking becomes necessary. The masking plan should also take into account the patient’s visual acuity and psychological status. For example, in patients with extremely low corrected visual acuity in one eye, after covering the healthy eye, the vision of the open poor eye cannot meet the requirements of daily walking and sports, learning, and even eating and dressing activities, so it is necessary to gradually extend the duration of coverage; for example, in older amblyopic patients, covering one eye during the day has a great impact on the appearance, so in order to take into account the patient’s psychological state and social activities, a short coverage program can be developed –The amblyopic patient is covered at home, alone or on rest days, and both eyes are open when going out and at school. For some patients who do not cooperate with masking because they are afraid of ugliness, trouble, or difficulty with sports, medication or optical suppression can be used as a partial or complete alternative to traditional masking. Sometimes, it is necessary to cover the poor eye to correct the paracentral gaze, i.e., inversion masking. 3. Suppression therapy The principle is to use over- or under-corrected lenses and daily atropine drops to suppress the function of the primary eye, while the amblyopic eye wears normal corrected lenses for distance or over-corrected lenses for near vision. (1) Suppression of near vision in the healthy eye: the healthy eye receives 1% atropine drops daily and wears corrective glasses with 2.00 or 3.00 spherical lenses on top of the corrective lenses in the amblyopic eye, forcing the patient to see far with the healthy eye and near with the amblyopic eye. (ii) Suppression of distance in the dominant eye: the dominant eye wears atropine drops and overcorrected 3.00 spherical lenses on the corrective lenses to make it difficult to see far, but to see near; the amblyopic eye wears all corrective lenses to see far. (iii) Complete depression: the primary eye wears atropine drops with undercorrected lenses, usually minus 5.00 spherical lenses available as negative lenses or reduced positive lenses; the amblyopic eye wears corrective lenses. This allows the primary eye to see neither near nor far. ④ Selective suppression: A. For those with over-regulated collections: Atropine drops in the primary eye, corrective lenses, and bifocal lenses in the amblyopic eye to promote near viewing and to reduce or eliminate the internal obliquity when looking at near. B. Maintenance and consolidation of the treatment effect: alternate suppression of both eyes. Atropine was discontinued in the primary eye and two pairs of glasses were prescribed, one pair of overcorrected 3.00 spherical lenses for the right eye and one pair of overcorrected 3.00 lenses for the left eye, and the two pairs of glasses were worn alternately on alternate days. The child sees far away with the right eye one day and far away with the left eye every other day to prevent recurrence of amblyopia. 4, posterior image therapy is the correction of paracentral gaze, improve visual acuity method, the use of protection of the central recess of the fundus, with 3o, 5o, 7o round black dot posterior image mirror, 6V15W strong light shine macular area, so that it produces posterior image, suppress paracentral gaze, excite the central vision function, at this time to look at the cross or visual acuity table can see the E word, twice a day, each time repeatedly do 2 ~ 3 times. 5, fine visual training using beads, needle, illustration, tracing, training chess cover healthy eyes and other products for fine visual training can consciously force the amblyopic eye to focus on a small target, so that their amblyopic eyes are inhibited photoreceptor cells are stimulated, lifting the inhibition, so as to improve visual acuity. 6, red filter method The macular area of the fundus contains only cone cells, cone cells are sensitive to red light, forcing the central concave gaze, inhibit the paracentral area, there are many such treatment instruments in China, the filter wavelength is 620 ~ 700nm, raw minutes flashing 60 ~ 80 times is appropriate. 7, medication Medication is generally through eating, paste, coating and other methods to ingest some of the drugs beneficial to the eyes, so as to relieve visual fatigue and improve visual acuity. 8.Food therapy Pay more attention to the nutritional mix of amblyopic children, if necessary, supplement some vitamin B1, vitamin B12, vitamin C, cod liver oil and zinc, iron, calcium, etc.. In addition, it is best not to let children eat overcooked protein-based food, so as to ensure that children have balanced nutrition. 9, Chinese medicine Chinese medicine is generally used to improve vision by massaging the acupuncture points around the eyes to relieve eye fatigue and promote blood flow to the eyes. 10.Binocular vision training For amblyopia patients with combined binocular vision impairment. Completing the visual enhancement amblyopia training and achieving corrected visual acuity of 1.0 or higher in both eyes is not the end point of amblyopia treatment. For example, the three most common types of amblyopia with combined binocular visual impairment are: strabismic amblyopia, refractive error amblyopia, and amblyopia with low initial visual acuity in both eyes. When a patient with amblyopia has corrected visual acuity above 0.6 in both eyes and has simultaneous perception, he or she can do binocular vision training. It is time to do binocular vision training. Binocular vision training can be roughly divided into three stages: simultaneous vision training, fusion training and stereo vision training. These three stages can be subdivided into targeted training to overcome visual dysfunction. Patients with amblyopia with a combined permanent strabismus should have surgery to correct the strabismus after the corrected visual acuity is close to normal, and do binocular vision training after surgery. 11, consolidation of amblyopia treatment Visual acuity is not the end of amblyopia treatment until it reaches the normal value (above 1.0 for decimal method and above 5.0 for logarithmic method) and after both eyes are visually sound. Stable achievement of the above criteria is the standard of amblyopia treatment. The Chinese Medical Association’s criteria for complete cure of amblyopia (established in 1987) are: corrected visual acuity greater than or equal to 0.9, stereo acuity less than or equal to 60″, and stability for more than three years.