Amblyopia and Corneal Opacity: A Patient's Journey

What are the issues related to amblyopia and corneal opacity?

Hello, Doctor! My case is a bit complicated, and the outpatient doctors have not been patient enough to listen.
Could you please help me evaluate my situation? Thank you! I am 33 years old.
Thirty years ago, when I was 3 years old, my right eye was injured by a pair of scissors, and I had an artificial lens implanted.
I only remember the doctor mentioning that my right eye might become amblyopic in the future, but I don't recall anything else.
Currently, my condition is as follows:
1.
My left eye has a myopia of about 300 degrees.
When viewing with both eyes, there is a 20% foggy area on the right side.
2.
When looking with my right eye alone, it appears as if there is a layer of fog obstructing my vision, making everything blurry.
3.
When I look straight ahead with my right eye at a distance of about 60 cm, I can discern the number of fingers being held up, but the resolution is still low.
4.
After the injury, I developed strabismus in my right eye, but over the years, it has returned to the correct position and can move together with the left eye.
5.
If I wear glasses with a prescription of -750 degrees for my right eye (as tested last week at the hospital), I still cannot clearly see the direction of the "E" on the vision chart even from three steps away; it only appears slightly brighter.
Last week, I visited a rather careless doctor at a hospital who only provided two diagnoses:
1.
Corneal opacity
2.
Artificial lens
The doctor implied that there was nothing more that could be done, stating that amblyopia could only remain as it is, and did not prescribe glasses, rushing off to see the next patient.
However, I have several questions I would like to clarify, and I hope you can take a look at these situations:
1.
Is the foggy vision caused by corneal opacity, or could there be additional contributing factors? However, the cornea appears very clear with no visible issues.
2.
After the initial corneal repair surgery following the scissor injury, is it inevitable that there would be irregularities leading to high astigmatism?
3.
If there are irregularities in the cornea or corneal opacity, can modern laser technology repair these issues?
4.
If I were to replace the artificial lens with a modern one, could it improve my vision?
I apologize for having so many questions, but I kindly ask for your assistance in reviewing these situations when you have the time.
Thank you very much!

KK, 30~39 year old female. Ask Date: 2016/10/13

Dr. Gao Pilin reply Ophthalmology

Hello KK,
1.
When a child suffers a corneal injury at the age of 3, it can lead to poor vision development.
Scarring may sometimes be invisible to the naked eye, and corneal injuries can cause irregular astigmatism, which also contributes to poor vision.
Additionally, if the lens is damaged and replaced with an artificial lens, these factors can lead to amblyopia.

2.
It is very likely.

3.
Laser treatment cannot repair the damage, and if amblyopia has already developed, vision will not be restored.

4.
Currently, there is no method to restore vision in cases of amblyopia.

Taiwan E-Hospital Puzi Hospital Ophthalmology: Monday to Friday from 8:00 AM to 12:00 PM, and Wednesday from 1:00 PM to 4:30 PM.
Online responses can only serve as a reference; it is necessary to seek medical attention at a healthcare facility.
I hope to have the opportunity to assist you.

Gao Pilin

Reply Date: 2016/10/13

More Info

Amblyopia, commonly known as "lazy eye," is a condition where one eye fails to achieve normal visual acuity, often due to a lack of proper visual stimulation during early childhood. In your case, the injury to your right eye at the age of three likely disrupted the normal visual development, leading to amblyopia. The presence of corneal opacity, which refers to clouding of the cornea, can further complicate the visual function of the affected eye.

1. Corneal Opacity and Visual Clarity: The "foggy" vision you are experiencing in your right eye could indeed be attributed to corneal opacity, but it may also be influenced by other factors such as the amblyopia itself and the presence of an artificial lens. While you mentioned that the cornea appears clear upon examination, it is possible that there are subtle irregularities or scarring that are not easily visible but still affect your vision. Additionally, the brain may not fully process the visual information from the injured eye due to the history of amblyopia.

2. Irregularities from Previous Surgery: Following the surgical repair of the cornea after your injury, it is common for the cornea to heal with some irregularities, potentially leading to astigmatism. Astigmatism occurs when the cornea is not perfectly spherical, causing blurred vision at all distances. This could explain why you are experiencing difficulty seeing clearly, even with corrective lenses.

3. Laser Surgery Options: Modern laser techniques, such as LASIK or PRK, can correct certain types of refractive errors, including astigmatism. However, the success of such procedures in your case would depend on the specific characteristics of your cornea and the overall health of your eye. A thorough evaluation by a corneal specialist would be necessary to determine if you are a suitable candidate for laser correction.

4. Artificial Lens Replacement: Replacing your current artificial lens with a more advanced intraocular lens (IOL) could potentially improve your vision, especially if the current lens is not providing optimal focus. Newer IOLs are designed to correct various refractive errors and may offer better visual outcomes. However, the decision to undergo lens replacement should be made after careful consideration and consultation with an ophthalmologist who specializes in cataract and lens surgery.

In summary, your visual challenges are likely multifactorial, stemming from the initial injury, subsequent amblyopia, and possibly the characteristics of your artificial lens. It is crucial to seek a comprehensive evaluation from an ophthalmologist who can provide a detailed assessment of your eye health and discuss potential treatment options tailored to your specific needs. This may include further imaging studies, a thorough refraction assessment, and a discussion about the risks and benefits of any proposed interventions. Your journey may be complex, but with the right medical guidance, there may be avenues to improve your visual function.

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