Amblyopia, or "lazy eye," is a common vision problem in children and is responsible for vision loss in more children than all other causes combined. Amblyopia is decreased vision of a child that results when one or both eyes send a blurry image to the brain. The brain does not learn to see clearly. Amblyopia may occur even when there is no observable structural abnormality of the eye. If amblyopia is not treated in a timely fashion, the vision loss may be permanent into adulthood.
What are the signs of amblyopia?
Amblyopia is present when a structurally normal eye doesn't see normally, even with the correct glasses. Because there are typically no outward signs of amblyopia, the only way to detect it is with an age-appropriate vision test. An assessment of the vision can be performed at any age by a pediatric ophthalmologist and by a pediatrician for children three years of age and older
What are the types of amblyopia?
The types and causes of amblyopia are: strabismic amblyopia, deprivation amblyopia, refractive amblyopia or a combination of the three. All forms of amblyopia result in reduced vision in the effected eye(s).
Are the signs for amblyopia similar to those of Strabismus?
Not necessarily. Strabismus can lead to amblyopia, but many cases of amblyopia do not have strabismus and are therefore not noticeable, even to the most observant parent. Strabismus is a condition in which the eyes do not stay straight in relation to each other and is a non-specific term for eye muscle imbalance. The eyes may be crossed in relation to each other (esotropia) or outward in relation to each other (exotropia). Less commonly, one eye may be elevated compared to the other (hypertropia). Children with strabismus may also have amblyopia, but most children with amblyopia do not have strabismus. Unlike strabismus, there are no outward signs of amblyopia.
What is strabismic amblyopia?
Strabismic amblyopia develops when the eyes are not aligned. When an eye turns in, out, up or down, the brain may "turn off" the eye that is not aligned and the vision subsequently decreases.
When and how is amblyopia treated?
Amblyopia is treated during childhood, and the earlier the age, the better the treatment result. Usually, by the age of 9-10 years the visual system is stable, and the vision does not improve much with treatment. However, vision improvement can occur at up to 17 years of age in some cases.
The underlying cause of the amblyopia is treated (correction of refractive error with glasses or contact lenses, removal of cataract, etc.) and then vision reassessed. If vision is still reduced, consideration is given to amblyopia treatment. The main forms of treatment are patches and drops. Occlusion treatment involves patching the better-seeing eye to stimulate vision in the poorer-seeing eye. The ophthalmologist prescribes the hours per day to patch based on the age of the child and the severity of vision deficit. Follow-up exams assess vision in the poorer-seeing eye for improvement and in the better-seeing eye to confirm no decrease in vision (occlusion amblyopia). In addition to an ophthalmologist, an orthoptist may be involved in the assessment and management of amblyopia. Orthoptists are allied health professionals that specialize in amblyopia and strabismus.
What kind of patch should be used?
The classic patch is an adhesive "Band-Aid®" type that is applied directly to the skin around the eye. These are available in different sizes for younger and older children. For children wearing glasses, a cloth patch slipped onto the glasses may be utilized. "Pirate" patches on elastic bands are not recommended due to easy removal by children.What if a child refuses to wear the patch?
Many children resist wearing a patch at first. Successful patching requires persistence and much encouragement from family members, neighbors, teachers, etc. Children often throw a temper tantrum but eventually learn not to remove the patch. A reward to the child for successful patching can be helpful. Usually cooperation improves as the vision improves.