Amblyopia

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.