Ambliyopi Tedavisi ve Güncel Yaklaşımlar
Özet
Ambliyopi (göz tembelliği), göz yollarında yapısal bozukluk olmaksızın, erken çocukluk dönemindeki anormal görsel gelişim nedeniyle görme keskinliğinin düşük olmasıdır. Hayatın ilk yıllarında gelişime açık olan bu tablo şaşılık, kırma kusurları (anizometropi, izometropi) ve yoksunluk (katarakt, pitozis) gibi faktörlerden kaynaklanır. Dünya genelinde %1-%5, Türkiye'de ise %0,6-%3,5 oranında görülmektedir. Tanıda tam oftalmolojik muayene ve yaşa uygun görme keskinliği testleri (Lea, Snellen vb.) kullanılır. Erken tanı için rutin tarama programları kritik öneme sahiptir. Tedavide sikloplejili muayene sonrası uygun gözlüklerin verilmesi ve az gören gözün çalıştırılması amacıyla sağlam gözün kapatıldığı kapama tedavisi altın standarttır. Kapamaya alternatif olarak atropin veya optik penalizasyon da tercih edilebilir. Son yıllarda, görme gelişimini tamamlamış ileri yaş olgularda veya standart tedavilere yanıt alınamayan durumlarda Levadopa/Carbidopa kullanımı, CAM stimülatörü, nörovizyon (Gabor görselleri), akupunktur, düşük doz makula lazer uygulamaları, video oyunları ve mavi/kırmızı ışık uyarıları gibi güncel ve alternatif tedavi yaklaşımları araştırılmaktadır. Sonuç olarak ambliyopi önlenebilir bir görme kaybı nedeni olup, başarısında erken tarama ve kapama tedavisi esastır.
Amblyopia, commonly known as lazy eye, is characterized by reduced visual acuity in one or both eyes without any structural defects in the visual pathways, arising from abnormal visual development during infancy and early childhood. The condition is primarily triggered by factors such as strabismus, refractive errors like anisometropia and isoametropia, and stimulus deprivation caused by congenital cataracts or ptosis. While its global prevalence ranges from 1% to 5%, it affects between 0.6% and 3.5% of the population in Turkey, necessitating comprehensive ophthalmological examinations and age-appropriate visual acuity assessments for accurate diagnosis. Early detection through routine screening programs is critical to mitigating its severity. The gold standard treatment remains refractive correction via eyeglasses combined with occlusion therapy, which forces the amblyopic eye to function by patching the stronger eye. Pharmacological or optical penalization can serve as alternative methods. Furthermore, contemporary approaches including Levodopa/Carbidopa therapy, CAM stimulation, Neurovision perceptual learning, acupuncture, low-level macular laser therapy, and specialized video games are increasingly explored, particularly for older patients or residual cases. Ultimately, amblyopia is a preventable cause of visual impairment where early intervention dictates success.
Referanslar
Holmes JM, Beck RW, Repka MX. Amblyopia. Current clinical studies; Ophthalmol Clin North Am. 2001;14:393-8.
von Noorden GK. Amblyopia: a multidisciplinary approach. Proctor lecture. Invest Ophthalmol Vis Sci. 1985;26:1704-1716.
O’Dwyer PA, Akova YA. Pediatrik Oftalmoloji ve Şaşılık: Pediatrik Oftalmoloji. In:O’Dwyer PA, eds. Temel Göz Hastalıkları. 2nd ed. Ankara; Güneş Tıp Kitabevleri; 2010:750-2.
Koçak G, Duranoğlu Y. Ambliyopi ve Tedavisi. Turk J Ophthalmol 2014; 44: 228-36.
Campos E. Amblyopia. Surv Ophthalmol. 1995;40(1):23-39.
Stewart CE, Moseley MJ, Fielder AR. Amblyopia therapy: an update. Strabismus. 2011;19:91-8.
Taylor K, Elliott S. Interventions for strabismicamblyopia. Cochrane Database Syst Rev. 2014;7:CD006461.
Sireteanu R, Fronius M. Different patterns of retinal correspondenee in the central and peripheral visual field of strabismics. Invest Ophthalmol Vis Sci 1989;30(9):2023-33.
Brooks SE, Johnson D, Fischer N. Anisometropia and binocularity. Opthalmology 1996;103: 1139-1143.
Weakley DR Jr. The association between nonstrabismic anisometropia, amblyopia and subnormal binocularity. Ophthalmology. 2001;108(1):163-71.
Bengisu Ü. Şaşılık. Göz hastalıkları. 4. Baskı. Ankara: Palme Yayıncılık, 1998:s.229-246.
Ziylan S, Yabas O, Zorlutuna N, Serin D. Isoametropic amblyopia in highly hyperopic children. Acta Ophthalmol Scand. 2007;85:111-3.
Barrett BT, Bradley A, Candy TR. The relationship between anisometropia and amblyopia. Prog Retin Eye Res. 2013;36:120-58.
Mansouri B, Stacy RC, Kruger J, Cestari DM. Deprivation amblyopia and congenital hereditary cataract. Semin Ophthalmol. 2013;28:321-6.
Diamond GR. Ocular manifestastion-amblyopia. Yanoff on CD-ROOM edition. Barcelona,Spain:Mosby international Ltd.:1996:12,1-6.
Yekta A, Fotouhi A, Hashemi H, et al. The prevalence of anisometropia, amblyopia and strabismus in schoolchildren of Shiraz, Iran, Strabismus. 2010;18:104-10.
Polling JR, Loudon SE, Klaver CC, Prevalence of amblyopia and refractive errors in an unscreened population of children, Optom Vis Sci. 2012;89:44-9.
Pai AS, Rose KA, Leone JF, et al. Amblyopia prevalence and risk factors in Australian preschool children. Ophthalmology. 2012;119:138-44.
Caca I, Cingu AK, Sahin A, et al. Amblyopia and refractive errors among school-aged children with low socioeconomic status in southeastern Turkey. J Pediatr Ophthalmol Strabismus. 2013;50:37-43.
Erdem Ü, Mutlu FM, Tatar K, Altınsoy Hİ. Investigation of the prevelance and causes of amblyopia in preschool children. TAF Prev Med Bull. 2004;3:202-12.
Demirel S, Gündüz A, Duman BŞ, Fırat P, Bakır S, Yakıncı C. Strabismus Prevalence in Primary Schools’ Children in Malatya. İnönü Üniversitesi Sağlık Bilimleri Dergisi. 2012;2:39-41.
Turaçlı EM, Aktan G, Dürük K. Ankara bölesinde farklı bölelerde ana ve ilkokullarda göz taraması sonuçları. T Oft Gaz. 1995;25:3-8.
Toygar O, Öğüt MS, Kozakoğlu H. İstanbul’da ilköğretim çağı çocuklarında yapılan göz taraması sonuçları. T Oft Gaz. 2003;33:585-91.
Bell AL, Rodes ME, Collier Kellar L. Childhood eye examination. Am Fam Physician. 2013;88(4):241-8. Erratum in: Am Fam Physician. 2014;89:76.
DeSantis D. Amblyopia. Pediatr Clin North Am. 2014;61:505-18.
Morad Y, Werker E, Nemet P. Visual acuity tests using chart, line, and single optotype in healthy and amblyopic children. J AAPOS. 1999;3(2):94-7.
Committee on Practice and Ambulatory Medicine, Section on Ophthalmology. American Association of Certified Orthoptists, American Association for Pediatric Ophthalmology and Strabismus, American Academy of Ophthalmology. Eye examination in infants, children, and young adults by pediatricians. Pediatrics. 2003;111:902–7.
Pediatric Eye Disease Investigator Group. The course of moderate amblyopia treated with patching in children: experience of the amblyopia treatment study. Am J Ophthalmol. 2003;136:620–9.
Çelik T. Ambliyopi ve Güncel Tedavi Yaklaşımları. JCP. 2017;15: (3):78-86.
Pediatric Eye Disease Investigator Group. A randomized trial of atropine vs. patching for treatment of moderate amblyopia in children. Arch Ophthalmol. 2002;120:268–78.
Pediatric Eye Disease Investigator Group. A comparison of atropine and patching treatments for moderate amblyopia by patient age, cause of amblyopia, depth of amblyopia, and other factors. Ophthalmology. 2003;110:1632–8.
Sachdeva V, Mittal V, Gupta V, Gunturu R, Kekunnaya R, Chandrasekharan A, et al.
Combined Occlusion and Atropine Therapy" Versus "Augmented Part-Time Patching" in Children with Refractory/Residual Amblyopia: A Pilot Study. Middle East Afr J Ophthalmol. 2016;23:201-7.
Kim JS, Jeon H, Jung HJ, et al. Comparison between over-glasses patching and adhesive patching for children with moderate amblyopia: a prospective randomized clinical trial. Graefes Arch Clin Exp Ophthalmol. 2018 Feb;256(2):429-437.
Rashad MA. Pharmacological enhancement of treatment for amblyopia. Clin Ophthalmol. 2012;6:409-16.
Sofi IA, Gupta SK, Bharti A, Tantry TG. Efficiency of the occlusion therapy with and without levodopa-carbidopa in amblyopic children-A tertiary care centre experience. . Int J Health Sci. 2016;10:249-57
Polat U, Ma-Naim T, Belkin M, Sagi D. Improving vision in adult amblyopia by perceptual learning. PNAS. 2004;101:6692-7.
Yalcin E, Balci O. Efficacy of pereptual vision therapy in enhancing visual acuity and contrast sensitivity function in adult hypermetropic anisometropic amblyopia. Gh. Clin Ophthalmol. 2014;8:49- 53.
Zhang JY, Cong LJ, Klein SA, Levi DM, Yu C. Perceptual learning improves adult amblyopic vision through rule-based cognitive compensation. Invest Ophthalmol Vis Sci. 2014;55:2020-30.
Gilven S, Uzunel D, Kose S, Uretmen Ö , Egrilmez S. Ambliyopi tedavisinde CAM görme uyaramnm etkinliği. Turk J Ophthalmol. 2007;37:149-55.
Zhao J. Randomized controlled trial of patching vs acupuncture for anisometropic amblyopia in children aged 7 to 12 years. Arch Ophthalmol. 2010;128:1510-7.
Li RW, Ngo C, Nguyen J, Levi DM. Video-game play induces plasticity in the visual system of adults with amblyopia. PLoS Biol. 2011;9:e1001135.
Ivandic BT, Ivandıc T. Low-level laser therapy improves visual acuity in adolescent and adult patients with amblyopia, Photomed Laser Surg. 2012;30:167-71.
