Amblyopia and Orthoptek as presented in AIOC 2022.pptx

Describes how orthoptek helps in amblyopia management

1. Amblyopia Dr .K.S.Santhan Gopal MD( AIIMS),FRCS(Edin)FRCophth Kamalanethralaya, Bangalore, India Past President - AIOS and KOS Orthóptek @carditek.com

2. Amblyopia and Orthóptek Definition Process of vision and perception Current management Future trends in therapy

3. Amblyopia - the definitions The old definition Reduced Visual Acuity with a difference of 2 lines acuity between the 2 eyes on the vision chart assessment The new definition Have we defined it yet? Perhaps it has to be redefined based on excluding all other causes for visual acuity reduction Perhaps on cerebral changes possibly defined by FMRI findings

4. Amblyopia : The Gold standard of treatment till now has been - Occlusion therapy ! Common causes : Strabismus Anisometropia High ametropia Visual deprivation Other visual deficits Hyperacuity Shape perception, Spatial interaction, Contour integration Visual counting, reduced or absent stereopsis Motion processing …

5. Amblyopia: The knowledge base The prerequisite for understanding the amblyopic eye: For the researcher and the opthalmic clinician - Neuro Anatomy, Neuro physiology Neuro pathology And all the ophthalmic skills

6. Cortical Aspects of Vision Vision has Dichotomous processes A well organised process from the retina to the cortex . There are parallel streams with horizontal connections There are top down and bottom up impulses The top-down streams modulate the bottom up impulses from retina to V1 layer

7. Amblyopia Cortical Aspects of Vision On Parvo & Magnocellular cells

8. Visual pathway structure The salient features Retinal fibers go to the Lateral geniculate body There is complete segregation of right and left eye fibers P and M fibres are also equally segregated Optic radiations from LGN go to lowest cortical at V1 layer

9. LGN is not a simple relay station only 30% of Retinal impulses are forwarded to cortex After Modification LGN also receives corticogeniculate modulating fibres from V1.

10. 4 3 6 5 2 1 Retina Parvocellular central area Magnocellular Peripheral area Retina Ventral Dorsal LGN LGN The dichotomous pathway carrying visual signals

11. Cortical vision The where and the wh at of Vision

12. Cortical aspects of vision 6 layers of visual cortex - layer 4 has 3 layers , A,B,C Right and left eye are segregated in Layer 4 as ocular dominance columns The M fibres end in layer 4C Alpha and P fibres end in 4C Beta M cells are for spatial vision (The where of vision ) P cells are for visual details and definition (The what of vision)

13. Cortical aspects of vision V1 : lowest connection Some M fibres reach the MT area directly

14. The occipital cortical connections A spaghetti junction !

15. Amblyopia - a brain abnormality Not only an eye abnormality !!! In amblyopia there is a functional / structural deficit in the visual cortex and the fMRI scans do show us the way forward The BOLD scans do show a drastic reduction in oxygen consumption in the cortex in Amblyopia

16. PET Scan

17. Amblyopia - the cortex The the cortical deficit : I s V1 the primary problem is it functional or structural are extrastriate areas worse than V1 deficit cortical processing deficit in amblyopia is extensive, involving large regions of extrastriate cortex besides V1.

18. Amblyopia - occlusion - the gold standard Shouldn’t we find a way more convenient , more result oriented and quicker than months of this ? Shouldn’t we utilize all our knowledge from cutting edge technologies and newer scanning data from FMRI and DTI PET technologies to better the approach to this ? Presenting Orthóptek from Carditek Medical devices

19. Orthóptek (MAGNOCELLULAR STIMULATOR) The instrument has 3 rows of light (LED) and central one is red in colour The lights come on for 300 mSec and are off for 300 mSec patient fixates on the lights , and points at it with a laser pointer. The patients are seated at a distance of 1 meter from the machine The procedure is conducted for 30 minutes with both eyes open and with weak eye only open

20. Amblyopia - in the era of Orthóptek Nearly 90% of patients recover from amblyopia In our series from my clinic - Vision - Stereopsis Improvement in hand eye coordination Improved self confidence Reduced nystagmus Strabismus

21. Amblyopia The summary : Amblyopia treatment has significant success at all ages with present day techniques Newer treatments with devices like Orthóptek , reduces time to recovery , to less than a few weeks for as little as 30 minutes a day The success rate of Orthóptek can easily be estimated at > 95% at 3-6 months of completion

22. I'm an Orthóptek Graduate !!!

23. Thank you from team Orthóptek We believe we shine! Mob:[phone] Email: [email protected] o rthoptek @gmail.com

24. Amblyopia - what do we notice ? 5 signs of lazy eye Irritated because of a lazy eye: The child stresses squints rubs Head tilt: to help the better eye catch the vision Difficulty reading or doing math: They must exert extra concentration effort, lazy eye may not perceive the numbers clearly due to fuzzy vision. Reduced motor skills: such as using scissors or tying shoelaces. Attention difficulties: focus and concentration