Amblyopia children are often accompanied by different degrees of ametropia, and ametropia is often an important factor in the formation of amblyopia, especially high hyperopia, astigmatism and anisometropia, so amblyopia patients need careful refractive examination. At the same time, for children with amblyopia, it is easy to be affected by eye adjustment factors in the process of refractive examination. It is particularly important to keep the adjustment relaxation of the examined eye as much as possible in the process of optometry. Generally, amblyopia patients need to have cycloplegia before refractive examination.

1. Introduction to optometry for children with amblyopia and ciliary paralysis

Drugs that relax eye regulation are called ciliary paralysis agents. Because the drug paralyzes the ciliary muscle and pupil sphincter of the human eye at the same time, the pupil of the tested eye is dilated. Therefore, this optometry method after ciliary muscle paralysis is also called "mydriatic optometry"; The optometry method without cycloplegic agent is called "pupillary optometry".

The commonly used ciliary muscle paralysis agent is anticholinergic drugs (M choline receptor blockers). Its action mechanism is that the drug acts on the choline receptor of ciliary muscle, so that the parasympathetic neurotransmitter acetylcholine can not bind to the choline receptor of ciliary muscle, so as to achieve the purpose of paralyzing ciliary muscle.

Children with amblyopia generally use the method of retinoscopy under ciliary paralysis combined with subjective inserting optometry. For children with good cooperation, they can also use a comprehensive optometer to conduct subjective optometry on the basis of retinoscopy or computer optometry to check the patient's refractive state, so as to determine whether amblyopia is caused by refractive state factors. The misdiagnosis of amblyopia can be avoided by reassessing the patient's vision under the best correction state.

2. Procedure of optometry for children with amblyopia and cycloplegia

(1) Decide whether cycloplegic optometry is needed and what kind of cycloplegic agent to use.

① People who use "slow dispersion".

1) First optometry for children under 8 years old.

2) Patients with deviated eye position.

3) Those suspected of regulating spasm.

② People who use "quick dispersion".

1) Amblyopia reexamination of children under 8 years old.

2) First visit and follow-up visit of children over 8 years old.

3) Under the small pupil optometry, the degree of myopia or hyperopia changes greatly compared with the previous one, so I doubt the results of small pupil optometry.

4) The refractive stroma is turbid, and it is difficult to check the exact degree by pupil optometry.

⑵ Optometry after cycloplegia

After selecting the appropriate cycloplegic agent and using it as required, carry out optometry, including objective optometry and subjective optometry, and obtain the accurate degree of the tested eye.

(3) Evaluate the adjustment state of the eye

Objective and subjective optometry in pupillary state was performed after the efficacy of cycloplegic agent disappeared, and then the adjustment state of the eye was evaluated. Try it on according to the actual situation of the subject and give the prescription for glasses. It is sometimes complicated to evaluate the adjustment state of the eye here, such as some patients with accommodative esotropia, abnormal visual function, poor corrected vision, and adjustment spasm after the efficacy of cycloplegic agent disappears and then appears in the retest under the condition of small pupil. Due to excessive adjustment tension in the process of pupil recovery after cycloplegic optometry, the degree of hyperopia or myopia may be too low during the retest, Therefore, some special amblyopia patients need glasses directly after cycloplegia optometry to avoid excessive tension regulation. For example, for patients with moderate to high hyperopia ametropia and amblyopia, in order to maintain the necessary adjustment tension, the optometry result of ciliary paralysis is reduced by + 1.00 ~ + 2.00d. Note that this value is not the degree of physiological hyperopia, but the adjustment tension of human eyes. At the same time, this value is only a pre estimate, because the adjustment tension cannot be precise, so there may be deviation; In addition, if hyperopia is accompanied by esotropia, glasses should be directly matched on the optometry results of ciliary paralysis. After cycloplegia optometry, patients with direct glasses need to be retested in the state of small pupil after the efficacy of cycloplegia disappears. The degree of retest needs to consider the recovery of eye position, visual function and amblyopia. During retest, if the prescription of glasses can not reach the best corrected vision, the lenses need to be replaced as appropriate.

Since children's refractive state has the development law of "emmetropia", the refractive examination results should also refer to the normal refractive physiological values of children of all ages.