Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- asymptomatic
- subnormal visual acuity for age in one or both eyes
- failure to ‘fix and follow’ in infants
- abnormal red reflex
Other diagnostic factors
- asymmetric corneal light reflex
- unequal behavioural response to alternate eye occlusion
- abnormal cover/uncover testing
- blurred vision
- eye strain
- congenital nystagmus
- abnormal pupil exam
- abnormal external eye exam
Risk factors
- age <9 years
- strabismus
- high (uncorrected) refractive errors
- media opacity
- severe ptosis or prolonged occlusion of one or both eyes
- prematurity
- family history of amblyopia or strabismus
- developmental delay
- structural abnormality of the retina or vitreous
Diagnostic investigations
1st investigations to order
- binocular red reflex test (Brückner test)
- visual acuity tests (monocular)
- stereopsis/binocular vision testing
- assessment of fixation, ocular alignment, and ocular motility
- anterior segment examination using a slit lamp
- dilated fundoscopy
- cycloplegic retinoscopy
Emerging tests
- visual evoked potentials (VEPs)
Treatment algorithm
without form-deprivation amblyopia
form-deprivation amblyopia
refractory amblyopia (non-compliant patient)
Contributors
Authors
Irene Gottlob, MD
Professor of Ophthalmology
Cooper University Health Care
Cooper Medical School
Rowan University
Glassboro
NJ
Disclosures
IG declares that she has no competing interests. IG is an author of references cited in this topic.
Gail Maconachie, PhD, BMedSci
Lecturer
School of Allied Health Professions, Nursing and Midwifery,
Faculty of Health
University of Sheffield
UK
Disclosures
GM declares that she has no competing interests. GM is an author of a reference cited in this topic.
Eleni Papageorgiou, MD, PhD
Consultant in Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology
Department of Ophthalmology
University Hospital of Larissa
Larissa
Greece
Disclosures
EP declares that she has no competing interests.
Acknowledgements
Dr Irene Gottlob, Dr Gail Maconachie, and Dr Eleni Papageorgiou would like to gratefully acknowledge Dr Tina Rutar, the previous contributor to this topic
Declarações
TR declared that she had no competing interests.
Revisores
Mary C. Whitman, MD, PhD
Assistant Professor of Ophthalmology
Boston Children’s Hospital
Harvard Medical School
Boston
MA
Declarações
MCW declares that she has no competing interests.
Nathan Cheung, OD, FAAO
Assistant Professor of Ophthalmology
Duke University
Durham
NC
Declarações
NC declares that he has no competing interests.
Michael Clarke, FRCS, FCOphth
Reader in Ophthalmology
Newcastle University
Newcastle
UK
Divulgaciones
MC has received NHS research grants of more than 6 figures USD. MC is an author of a number of references cited in this topic.
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Referencias
Artículos principales
American Academy of Ophthalmology. Amblyopia PPP 2022 - updated 2024. Dec 2022 [internet publication].Texto completo
Hutchinson AK, Morse CL, Hercinovic A, et al. Pediatric eye evaluations preferred practice pattern. Ophthalmology. 2023 Mar;130(3):P222-70.Texto completo Resumen
US Preventive Services Task Force; Grossman DC, Curry SJ, Owens DK, et al. Vision screening in children ages 6 months to 5 years: US Preventive Services Task Force Recommendation Statement. JAMA. 2017 Sep 5;318(9):836-44.Texto completo Resumen
American Academy of Ophthalmology. Pediatric ophthalmology/strabismus summary benchmarks - 2024. Dec 2024 [internet publication].Texto completo
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Refractive error with no amblyopia
- Functional visual impairment
- Central nervous system pathology affecting visual pathways
Más DiferencialesGuías de práctica clínica
- Amblyopia preferred practice pattern
- Pediatric ophthalmology/strabismus summary benchmarks
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