Refractive correction plays a key role in the treatment of all types of amblyopia, not just refractive amblyopia. Anisometropic, isoametropic, and even strabismic amblyopia may improve or resolve with refractive correction alone. Many ophthalmologists thus initiate amblyopia treatment with refractive correction, adding occlusion or pharmacologic or optical treatment later if necessary (see the following sections). Refractive correction for aphakia following cataract surgery in childhood is initiated promptly to avoid prolonging visual deprivation. For patients with high refractive error that is amblyogenic who will not or cannot wear glasses or contact lenses, refractive surgery may be an alternative in select cases.
In general, refractive correction in amblyopia should be based on the cycloplegic refraction. Often, full hyperopic correction is necessary to treat coexisting accommodative esotropia (see Chapter 8). Furthermore, because an amblyopic eye tends to have an impaired ability to control accommodation, it cannot reliably compensate for uncorrected hyperopia as would a child’s normal eye. Thus, children with unilateral or bilateral amblyopia may need full or nearly full correction of their hyperopia during amblyopia treatment even if they do not have accommodative esotropia. Also, by ensuring clear distance vision in the fellow eye even under cycloplegia, full hyperopic correction may reduce the risk of reverse amblyopia, which can result from pharmacologic treatment with atropine (see the section “Reverse amblyopia and new strabismus”). Sometimes, however, symmetric reductions in plus-lens power help foster acceptance of glasses.
Writing Committee for the Pediatric Eye Disease Investigator Group; Cotter SA, Foster NC, Holmes JM, et al. Optical treatment of strabismic and combined strabismic-anisometropic amblyopia. Ophthalmology. 2012;119(1):150–158.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.