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Amblyopia is a vision condition that impacts the clarity of sight in both eyes, typically manifesting during infancy or early childhood and potentially worsening without intervention. The development of amblyopia generally occurs from birth up to the age of 7. In individuals with amblyopia, one eye experiences blurred vision, while the other maintains clear vision. Consequently, the brain tends to disregard the blurry eye, relying solely on the eye with better vision. Over time, this preference for the stronger eye exacerbates the visual impairment in the weaker eye. Seeking treatment from an eye care specialist is crucial for addressing amblyopia, as it is a significant medical concern.
Timely diagnosis and intervention are essential to prevent potential long-term vision issues. Treatment options typically include correcting the vision in the weaker eye with glasses or contact lenses, as well as employing patching therapy.
Symptoms
Detecting amblyopia in children can be challenging, as it often goes unnoticed until a healthcare professional or eye care specialist conducts an examination. However, if your child is exhibiting symptoms of amblyopia, you may observe alterations in their interaction with objects and spatial awareness. Signs of amblyopia in a child can include:
- Frequently closing one eye or squinting.
- Tilting their head to one side on a regular basis.
- Colliding with objects, particularly on one side of their body.
- Having crossed eyes.
- Displaying a preference for one side of their body.
- Possessing a droopy eyelid.
Causes
Lazy eye develops due to abnormal visual experiences early in life, leading to alterations in nerve pathways between the retina at the back of the eye and the brain. This results in the weaker eye receiving fewer visual signals, causing a decrease in the ability of the eyes to work together. The brain may suppress or ignore input from the weaker eye over time.
Various factors can contribute to the development of lazy eye, including:
- Muscle imbalance (strabismus amblyopia): The most prevalent cause of lazy eye is an imbalance in the muscles that position the eyes. This imbalance can cause the eyes to cross or turn out, preventing them from coordinating effectively.
- Difference in sharpness of vision between eyes (refractive amblyopia): Lazy eye can occur when there is a significant difference in prescription between the eyes, often due to farsightedness, nearsightedness, or astigmatism. Correcting these refractive problems with glasses or contact lenses is a common approach. In some cases, lazy eye may result from a combination of strabismus and refractive issues.
- Deprivation: Problems affecting one eye, such as a cloudy area in the lens (cataract), can impede clear vision in that eye. Deprivation amblyopia, particularly in infancy, requires prompt treatment to prevent permanent vision loss and is often the most severe form of amblyopia.
Prompt intervention, such as the use of glasses or contact lenses to correct refractive issues, is crucial in addressing lazy eye. Additionally, addressing muscle imbalances and treating deprivation amblyopia in infancy is essential to prevent long-term vision impairment.
Risk factors
Any person can develop lazy eye. However, certain factors may contribute to one’s risk of developing one, such as:
- Having family members who struggle with vision and eyesight issues.
- Premature birth, such being delivered before 37 weeks of pregnancy.
- Low birth weight, such as weighing less than five pounds at delivery.
- Delays in development.
Diagnosis
During an eye examination, your doctor will assess various aspects of eye health and vision. This includes checking for conditions such as a wandering eye, disparities in vision between the eyes, or overall poor vision. To facilitate this examination, eyedrops are often administered to dilate the pupils, leading to temporary blurred vision that may last several hours or a day.
The testing method employed depends on the child’s age and developmental stage:
- Preverbal children:
- A lighted magnifying device may be utilized to detect cataracts.
- Other tests assess an infant’s or toddler’s ability to fix their gaze and track a moving object.
- Children ages 3 and older:
- Vision can be evaluated using tests involving pictures or letters.
- Each eye is covered sequentially to assess the vision of the other eye.
Treatment
Initiating treatment for lazy eye in childhood is crucial, especially during the formative period when intricate connections between the eye and the brain are developing. The optimal outcomes are achieved when treatment commences before the age of 7, although a significant proportion of children aged 7 to 17 respond positively to treatment.
The choice of treatment depends on the underlying cause of lazy eye and the extent to which it impacts a child’s vision. Treatment options may include:
- Corrective eyewear: Glasses or contact lenses can address issues like nearsightedness, farsightedness, or astigmatism contributing to lazy eye.
- Eye patches: To stimulate the weaker eye, a child wears an eye patch over the stronger eye for two to six or more hours per day. Prolonged use may rarely lead to the development of amblyopia in the patched eye, but this is typically reversible.
- Bangerter filter: Placed on the lens of the stronger eye’s glasses, this filter blurs the vision in the stronger eye, functioning similarly to an eye patch to stimulate the weaker eye.
- Eyedrops: Atropine eye drops temporarily blur vision in the stronger eye, encouraging the use of the weaker eye. Typically prescribed for weekend or daily use, potential side effects include light sensitivity and eye irritation.
- Surgery: Surgical intervention may be necessary if a child has droopy eyelids or cataracts leading to deprivation amblyopia. Surgical repair to straighten the eyes might also be recommended if eye misalignment persists despite wearing appropriate glasses.
- Activity-based treatments: While activities like drawing, puzzles, or computer games are available, their effectiveness as additions to other therapies remains unproven. Ongoing research explores new treatment modalities.
For most children with lazy eye, proper treatment yields improvements in vision within weeks to months, with the duration of treatment ranging from six months to two years. Monitoring for potential recurrence, which can occur in up to 25 percent of cases, is crucial. If a relapse occurs, treatment will need to be reintroduced.
