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Between 2 and 5% of the population in western countries have amblyopia. In the U.K., 90% of visual health appointments in the child are concerning amblyopia.
Depending on the chosen criterion for diagnosis, between 1 and 4% of the children have amblyopia.
Aphakia is the absence of the lens of the eye, due to surgical removal, a perforating wound or ulcer, or congenital anomaly. It causes a loss of accommodation, far sightedness (hyperopia), and a deep anterior chamber. Complications include detachment of the vitreous or retina, and glaucoma.
Babies are rarely born with aphakia. Occurrence most often results from surgery to remove congenital cataract (clouding of the eye's lens, which can block light from entering the eye and focusing clearly). Congenital cataracts usually develop as a result of infection of the fetus or genetic reasons. It is often difficult to identify the exact cause of these cataracts, especially if only one eye is affected.
People with aphakia have relatively small pupils and their pupils dilate to a lesser degree.
Amblyopia, also called lazy eye, is a disorder of sight due to the eye and brain not working well together. It results in decreased vision in an eye that otherwise typically appears normal. It is the most common cause of decreased vision in a single eye among children and younger adults.
The cause of amblyopia can be any condition that interferes with focusing during early childhood. This can occur from poor alignment of the eyes, an eye being irregularly shaped such that focusing is difficult, one eye being more nearsighted or farsighted than the other, or clouding of the lens of an eye. After the underlying cause is fixed, vision is not restored right away, as the mechanism also involves the brain. Amblyopia can be difficult to detect, so vision testing is recommended for all children around the ages of four to five.
Early detection improves treatment success. Eye glasses may be all the treatment needed for some children. If this is not sufficient, treatments which force the child to use the weaker eye are used. This is done by either using a patch or putting atropine in the stronger eye. Without treatment, amblyopia typically persists into adulthood. Evidence regarding treatments for adults is poor.
Amblyopia begins by the age of five. In adults, the disorder is estimated to affect 1–5% of the population. While treatment improves vision, it does not typically restore it to normal in the affected eye. Amblyopia was first described in the 1600s. The condition may make people ineligible to be pilots or police officers. The word amblyopia is from Greek ἀμβλύς "amblys" meaning "blunt" and ὤψ "ōps" meaning "sight".
Without the focusing power of the lens, the eye becomes very farsighted. This can be corrected by wearing glasses, contact lenses, or by implant of an artificial lens. Artificial lenses are described as "pseudophakic." Also, since the lens is responsible for adjusting the focus of vision to different lengths, patients with aphakia have a total loss of accommodation.
Some individuals have said that they perceive ultraviolet light, invisible to those with a lens, as whitish blue or whitish-violet.
Causes of photophobia relating directly to the eye itself include:
- Achromatopsia
- Aniridia
- Anticholinergic drugs may cause photophobia by paralyzing the iris sphincter muscle.
- Aphakia (absence of the lens of the eye)
- Blepharitis
- Buphthalmos (abnormally narrow angle between the cornea and iris)
- Cataracts
- Coloboma
- Cone dystrophy
- Congenital abnormalities of the eye
- Viral conjunctivitis ("pink eye")
- Corneal abrasion
- Corneal dystrophy
- Corneal ulcer
- Disruption of the corneal epithelium, such as that caused by a corneal foreign body or keratitis
- Ectopia lentis
- Endophthalmitis
- Eye trauma caused by disease, injury, or infection such as chalazion, episcleritis, glaucoma, keratoconus, or optic nerve hypoplasia
- Hydrophthalmos, or congenital glaucoma
- Iritis
- The drug isotretinoin (Accutane/Roaccutane) has been associated with photophobia
- Optic neuritis
- Pigment dispersion syndrome
- Pupillary dilation (naturally or chemically induced)
- Retinal detachment
- Scarring of the cornea or sclera
- Uveitis
Patients may develop photophobia as a result of several different medical conditions, related to the eye or the nervous system. Photophobia can be caused by an increased response to light starting at any step in the visual system, such as:
- Too much light entering the eye. Too much light can enter the eye if it is damaged, such as with corneal abrasion and retinal damage, or if its pupil(s) is unable to normally constrict (seen with damage to the oculomotor nerve).
- Due to albinism, the lack of pigment in the colored part of the eyes (irises) makes them somewhat translucent. This means that the irises can't completely block light from entering the eye.
- Overstimulation of the photoreceptors in the retina
- Excessive electric impulses to the optic nerve
- Excessive response in the central nervous system
- Elevated trigeminal nerve tone (as it is sensory nerve to eye, elevated tone makes it over reactive). Elevated trigeminal tone causes elevated substance P which causes hypersensitivity. Often due to jaw misalignment.
Common causes of photophobia include migraine headaches, TMJ, cataracts, Sjogren's Syndrome, Mild Traumatic Brain Injury (MTBI), or severe ophthalmologic diseases such as uveitis or corneal abrasion. A more extensive list follows:
Retinal image size is determined by many factors. The size and position of the object being viewed affects the characteristics of the light entering the system. Corrective lenses affect these characteristics and are used commonly to correct refractive error. The optics of the eye including its refractive power and axial length also play a major role in retinal image size.
Aniseikonia can occur naturally or be induced by the correction of a refractive error, usually anisometropia (having significantly different refractive errors between each eye) or antimetropia (being myopic (nearsighted) in one eye and hyperopic (farsighted) in the other.) Meridional aniseikonia occurs when these refractive differences only occur in one meridian (see astigmatism). Refractive surgery can cause aniseikonia in much the same way that it is caused by glasses and contacts.
One cause of significant anisometropia and subsequent aniseikonia has been aphakia. Aphakic patients do not have a crystalline lens. The crystalline lens is often removed because of opacities called cataracts. The absence of this lens left the patient highly hyperopic (farsighted) in that eye. For some patients the removal was only performed on one eye, resulting in the anisometropia / aniseikonia. Today, this is rarely a problem because when the lens is removed in cataract surgery, an intraocular lens, or IOL is left in its place.
When this magnification difference becomes excessive the effect can cause diplopia, suppression, disorientation, eyestrain, headache, and dizziness and balance disorders.
Predisposing factors for Postoperative PVR are preoperative PVR, aphakia, high levels of vitreous proteins, duration of retinal detachment before corrective surgery, the size of the retinal hole or tear, intra-ocular inflammation, vitreous hemorrhage, and trauma to the eye. An equation to calculate the patient's risk for acquiring PVR is:
1 is added if the risk factor is present and 0 if the risk factor is absent. A patient is at a high risk for developing PVR is the PVR score is >6.33.
Proliferative vitreoretinopathy (PVR) is a disease that develops as a complication of rhegmatogenous retinal detachment. PVR occurs in about 8–10% of patients undergoing primary retinal detachment surgery and prevents the successful surgical repair of rhegmatogenous retinal detachment. PVR can be treated with surgery to reattach the detached retina but the visual outcome of the surgery is very poor.
PVR was originally referred to as massive vitreous retraction and then as massive periretinal proliferation. The name Proliferative vitreo retinopathy was provided in 1989 by the Silicone Oil Study group. The name is derived from "proliferation" (by the retinal pigment epithelial and glial cells) and "vitreo retinopathy" to include the tissues which are affected, namely the vitreous humor (or simply vitreous) and the retina.