Research: Putting a stop to laziness

Bill Harvey describes recent advances in the detection & management of amblyopia

I have long thought that the management of amblyopia could be better. Whether caused by ametropia, strabismus or deprivation, the loss of vision caused by amblyopia is still measured by subjective acuity scoring and managed primarily by occlusion. This approach has changed little, to my mind, since my mother’s ‘lazy eye’ was referred to the old Birmingham and Midland Eye Hospital (now an Hotel du Vin in the middle of town).

So, any new developments are always of interest and the many advances in electronic instrumentation are finally having some impact in both the early detection and treatment of amblyopia.

Autorefraction, carried out binocularly either with or without cycloplegia, has now been accepted and endorsed by the American Academy of Pediatrics as a valid vision screening method. Instruments such as the PlusOptix (from Carleton, figure 1) and the Spot Vision Screener (Welch Allyn, figure 2, below) offer rapid, accurate and, importantly, binocular refraction while digital capture also helps to detect even a small deviation from forward fixation.

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