What is amblyopia?
A common vision problem in children is amblyopia, or “lazy eye.” It is so common that it is the reason for more vision loss in children than all other causes all together. Amblyopia is a decrease in the child’s vision that can happen even when there is no problem with the structure of the eye. The decrease in vision results when one or both eyes send a blurry image to the brain. The brain then “learns” to only see blurry with that eye, even when glasses are used. Only children can get amblyopia. If it is not treated, it can cause permanent loss of vision.
Will glasses help a child with amblyopia to see better?
With amblyopia, the brain is “used to” seeing a blurry image and it cannot interpret the clear image that the glasses produce. With time, however, the brain may “relearn” how to see and the vision may increase.
What can be done if my child has equal high amounts of refractive error and is diagnosed with bilateral amblyopia?
Bilateral amblyopia is usually treated with consistent, early glasses with follow-up over a long period of time. If asymmetric amblyopia (one eye better than the other) occurs, then patching or eye drops may be added.
When should amblyopia be treated?
Early treatment is always best. Children with cataracts or other “amblyogenic” conditions are usually treated promptly in order to minimize the development of amblyopia.
How can I get early treatment for amblyopia for my child?
Parents easily detect sometimes amblyopia associated with large amount of squint. Other types of amblyopia (from high refractive error) might cause a child to move very close to objects or squint his or her eyes. Still other forms of amblyopia may NOT be obvious to parents and therefore must be detected by timely Vision Screening.
What is Vision Screening?
Vision Screening is strongly recommended by Paediatric Ophthalmologists/ Child eye Specialists over the course of childhood to detect Childhood eye disorders timely. Pediatricians check newborns for red reflex to find congenital cataracts. Infants are checked for the ability to fix and follow and whether they have squint. Toddlers can have their pupillary red reflexes tested with a direct ophthalmoscope (Bruckner Test) or by photoscreening, or by remote autorefraction to identify refractive errors that can cause amblyopia. When children can consistently identify objects either by reading, or by matching, the acuity of each eye (with the non-tested eye patched or covered) is screened to identify amblyopia.
How is amblyopia treated?
One of the most important treatments of amblyopia is correcting the refractive error with consistent use of glasses. Other mainstays of amblyopia treatment are to enable as clear an image as possible (for example, by removing a cataract), and forcing the child to use the nondominant eye (via patching or eyedrops to blur the better-seeing eye).
When should patching be used for amblyopia treatment?
Patching should only be done if an ophthalmologist recommends it. An ophthalmologist should regularly check how the patch is affecting the child’s vision. Although it can be hard to do, patching usually works very well if started early enough and if the parents and child follow the patching instructions carefully. It is important to patch the dominant eye to allow the weak eye to get stronger.
Are there different types of patches?
The classic patch is an adhesive “Band-Aid” which is applied directly to the skin around the eye. These may be available in different sizes for younger and older children. “Pirate” patches on elastic bands are especially prone to “peeking” and are therefore only occasionally appropriate.
Is there an alternative to patching to treat amblyopia?
Sometimes the stronger (good) eye can be “penalized” or blurred to help the weaker eye get stronger. Blurring the vision in the good eye with drops or with extra power in the glasses will penalize the good eye.
How many hours per day patching is enough when treating amblyopia?
The mainstay of treating amblyopia is patching of the dominant (good) eye, either full or part-time during waking hours. Recent studies suggest that shorter periods may achieve similar results as longer amounts of patching in patients with moderate amounts of amblyopia.
How long does patching therapy take to work?
Although vision improvement frequently occurs within weeks of beginning patching treatment, optimal results often take many months. Once vision has been improved, part-time (maintenance) patching is necessary. This maintenance treatment may be advisable for several months to years.
During which activities should patching be performed?
Patching is advisable during near activities, which the child finds interesting or playful & during reading activities in older children.
What if my child refuses to wear the patch?
Many children will resist wearing a patch at first. Successful patching may require persistence and plenty of encouragement from family members, neighbors, teachers, etc. Children will often throw a temper-tantrum, but then they eventually learn not to remove the patch. Another way to help is to provide a reward to the child for keeping the patch on for the prescribed time period.
What happens if amblyopia treatment does not work?
In some cases, treatment for amblyopia may not succeed in substantially improving vision. It is hard to decide to stop treatment, but sometimes it is best for both the child and the family. Children who have amblyopia in one eye and good vision only in their other eye can wear safety glasses and sports goggles to protect the normal eye from injury. As long as the good eye stays healthy, these children function normally.