ICO International Clinical Guidelines:
Amblyopia (Initial and Follow-up Evaluation)
(You can also download this Guideline as a PDF file - 110 KB)
More on the Guidelines:
On this page:
- Initial exam history
- Initial physical exam
- Care management
- Follow-up evaluation
- Amblyopia follow-up evaluation intervals during active
treatment period
- Patient education
Initial Exam History (Key elements)
- Ocular symptoms and signs [A:III]
- Ocular history [A:III]
- Systemic history, including review of prenatal, perinatal, and postnatal medical factors [A:III]
- Family history, including eye conditions and relevant systemic diseases [A:III]
Initial Physical Exam (Key elements)
- Visual acuity [A:III]
- Assessment of fixation pattern [A:III]
- Pupil reactivity and function [A:III]
- Ocular alignment and motility [A:III]
- External examination: lids, lashes, lacrimal apparatus, orbit, face [A:III]
- Evaluation of the fundus (including posterior pole of retina) [A:III]
- Cycloplegic refraction [A:III]
Care Management
- Provide ongoing management until approximately age 10 years. [A:III]
- Choose treatment to meet the patient's visual, physical, social and psychological needs and based on potential risks and benefits for the patient. [A:III]
- Treatment goal is to achieve equalization/normalization of fixation patterns or visual acuity. [A:III]
- Once maximal visual acuity has been obtained, treatment should be tapered or stopped. [A:III]
Follow-up Evaluation
- Follow-up visits should include:
- Amount of occlusion and/or spectacle wear achieved by report [A:III]
- Side effects (e.g., skin irritation, ocular redness, flushing and psychosocial issues) [A:III]
- Visual acuity or fixation of each eye [A:III]
- Ocular alignment [A:III]
- Repeat cycloplegic refraction, as indicated (at least yearly, and 4-6 month intervals may be necessary) [A:III]
- Amount of occlusion and/or spectacle wear achieved by report [A:III]
Amblyopia Follow-up Evaluation Intervals During Active Treatment Period (A:III)
|
Age (years) |
High Percentage Occlusion (>70% of waking time) |
Low Percentage Occlusion (>70% of waking time) or Penalization |
Maintenance Treatment or Observation |
|
0-1 |
Days to 4 weeks |
2-8 weeks |
1-4 months |
|
1-2 |
2-8 weeks |
2-4 months |
2-4 months |
|
2-3 |
3-12 weeks |
2-4 months |
2-4 months |
|
3-4 |
4-16 weeks |
2-6 months |
2-6 months |
|
4-5 |
4-16 weeks |
2-6 months |
2-6 months |
|
5-7 |
6-16 weeks |
2-6 months |
2-6 months |
|
7-9 |
8-16 weeks |
3-6 months |
3-12 months |
|
Over 9 |
8-16 weeks |
3-6 months |
6-12 months |
Patient Education
- Discuss diagnosis, severity of disease, prognosis and treatment plan with patient, parents and/or caregivers. [A:III]
- Develop a team approach with the patient, family/caregiver and others such as teachers or day-care providers, giving attention to visual, psychological, social and economic factors, and assuring that they understand the disease process, rationale and goals of treatments, and the benefits and complications. [A:III]
- Discuss potential psychological side effects with the parent/caregiver. [A:III]
- Explain the importance of monitoring and long-term follow-up of the problem with the parent/caregiver and patient. [A:III]
* Adapted from the American Academy of Ophthalmology Summary Benchmarks, November 2006 (www.aao.org)
(You can also download this Guideline as a PDF file - 110 KB)
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