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Catching Childhood Vision Problems Early Ilene Raymond Rush Amblyopia, also known as lazy eye, affects only two to three percent of the population. But if uncorrected, this vision problem can interfere with proper development of sight. A related condition, strabismus or crossed eye, sometimes causes amblyopia. Untreated amblyopia can result in functional blindness in the affected eye. Although the amblyopic eye has the capability to see, the brain "turns off" this eye because vision is very blurred. The brain then elects to see only with the dominant eye.
Why should parents take a child to a pediatric ophthalmologist? Children are really not just “small adults”. Pediatric ophthalmologists are dedicated to examine ocular health and visual development and the proper diagnosis and early treatment of eye issues that occur exclusively in children. From infancy to age 9, a pediatric ophthalmologist is better qualified to perform a thorough eye exam to rule out sight-threatening issues. Many eye care practitioners who are not physicians may test a child's vision with devices traditionally used for adults, often the "better one or better two" instrument called a phoropter. This subjective test can confuse children and it cannot be done in preverbal children. It also can lead to incorrect, too strong or unnecessary prescriptions for glasses. What should parents expect in a child's eye exam? Young children have a short attention span, and are best examined earlier in the day. A good examiner will be animated and quick, making a "game" out of many of the tests. Since babies and preverbal children cannot read the eye chart, they must have their pupils dilated with special drops that allow the doctor to look inside the eye with an instrument called a "retinoscope" that helps to evaluate the ability of the eye to focus. This allows us to tell whether a child is nearsighted, farsighted, has astigmatism, or is developing a "lazy eye." Dilation can be stressful for both parents and children, since the drops can be mildly uncomfortable. But it is a very important part of an accurate exam in children and also allows us to rule out cataracts and retinal issues. What causes amblyopia? Lazy eye or amblyopia is reduced vision in one or both eyes, due to disuse or neglect of that eye by the brain. It is not the same thing as a wandering, or a crossed eye, which is called "strabismus." Strabismus can cause amblyopia, however. Other causes of amblyopia include a high focusing error in one eye, which leads to blurred vision, or lack of light getting into the eye, caused by a droopy eyelid or a cataract. A child's vision actively develops from birth until ages 9 or 10. Anything that interferes with this visual development can lead to lazy eye. If a child receives a diagnosis of amblyopia where one or both eyes are very out of focus, treatment often includes glasses and a patch placed over the dominant eye, to encourage the lazy eye to work harder and develop better focus. How long will treatment take? While patching therapy is very successful, it can take years and when to stop the patching therapy is controversial. Once, physicians believed that the ‘magic age’ was eight, since it was believed that the eye stopped developing at that age, but recent studies refute this. New research shows that even older children – particularly those who have never been treated with a patch – can benefit from patching. They also reveal that that stopping the patching at age 8 can sometimes lead to regression of the vision. In my practice, I have patients continue to patch through age 10, if possible, even if it is just for 1 hour per day. The amount of patching varies with the severity of the amblyopia. Recent studies by the Pediatric Eye Disease Investigator Group (PEDIG), a multicenter network, have shown that patching greater that 6 hours probably does not help. PEDIG also compared two amblyopia treatments -- patching versus atropine eye drops that blur vision in the stronger eye for 5-7 days. Initial improvement was better in the patching group, but after 6 months, the difference between treatment groups was not significant. More patients in the patching group obtained 20/25 vision than in the atropine group. Unfortunately, beyond age 12 or 13, no one has really proven that amblyopic therapy works. It definitely works better with younger children. So diagnosing amblyopia early is vital. How you decide whether to patch or to use atropine drops? I use atropine drops for infants and small children who will not wear the patch. It is generally well tolerated with a few minor side effects like light sensitivity. In older children, I convince them to patch, since the atropine causes sustained blurriness, which may affect them at school. |
 Detecting Amblyopia If you notice any of the following symptoms, make an appointment with an eye doctor for your child to have a comprehensive eye examination:
* Eyes that appear to be crossed What you need to know about lazy eye: |
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To understand the importance of early diagnosis and treatments for lazy eye, we spoke to Dr. Sepideh T. Rousta, a New Jersey pediatric opthamologist and researcher.
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