When to Change Glasses for Amblyopia: Expert Insights for Parents

The timing for changing lenses in cases of amblyopia?

Hello: My daughter is 5 years and 8 months old.
Her right eye vision is 1.0, while her left eye has hyperopia of +4.00 and astigmatism of +1.00.
She is currently undergoing glasses correction and patching therapy.
We have consulted two doctors; one suggested that if her prescription improves, we should not change the glasses prescription, and only adjust it if her vision stabilizes without improvement.
The other doctor recommended that any change in prescription should prompt a change in the glasses lenses to prevent frequent adjustments.
To avoid rapid changes in prescription, they suggested using cycloplegic drops and indicated that patching is only necessary for 2-3 hours a day, during which she can also engage in amblyopia training.
Additionally, after wearing glasses, her measured vision is 0.7, and she sometimes reports difficulty seeing clearly.
She also experiences headaches after prolonged reading or drawing.
Is this normal? Thank you for your time and assistance.

purplrbell, 30~39 year old female. Ask Date: 2017/08/30

Dr. Cai Wenyuan reply Ophthalmology

Hello, regular and timely check-ups should suffice.
Wishing you safety and health.
Sincerely, Dr.
Tsai Wen-Yuan, Director of the Ophthalmology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2017/08/30

More Info

When it comes to managing amblyopia (commonly known as "lazy eye") in children, particularly regarding when to change glasses, there are several important considerations that parents should keep in mind. Your daughter, at 5 years and 8 months, is at a critical age for visual development, and the decisions made now can significantly impact her long-term vision.

Understanding Amblyopia and Treatment
Amblyopia occurs when one eye does not develop proper vision during childhood, often due to issues such as refractive errors (like hyperopia or astigmatism), strabismus (misalignment of the eyes), or other visual impairments. The goal of treatment is to improve the vision in the weaker eye, which often involves the use of corrective lenses and occlusion therapy (patching the stronger eye).

When to Change Glasses
1. Monitoring Vision Changes: The advice from the two doctors you consulted reflects a common dilemma in amblyopia management. The first doctor suggests waiting for significant improvement before changing the prescription, while the second emphasizes the importance of adjusting the prescription whenever there is a measurable change.
- Recommendation: If your daughter’s vision is improving, it may be wise to hold off on changing her glasses immediately. However, if her vision plateaus or worsens, it would be prudent to reassess her prescription. Regular eye exams are crucial, typically every 6 months to a year, to monitor her progress.

2. Use of Cycloplegic Drops: The second doctor’s suggestion to use cycloplegic drops (which temporarily paralyze the ciliary muscle of the eye) can help in obtaining a more accurate measurement of refractive error. This can prevent the prescription from changing too rapidly and causing frequent adjustments, which can be frustrating for both the child and the parents.

3. Duration of Patching: The recommendation to patch for 2-3 hours a day is consistent with current practices. The key is to ensure that the patching is effective without causing excessive discomfort or fatigue. If your daughter is experiencing headaches or discomfort while reading or drawing, it may indicate that her current prescription is not optimal or that she is straining her eyes.

Addressing Symptoms of Discomfort
- Headaches and Visual Strain: It is not uncommon for children to experience headaches when they are using their eyes for extended periods, especially if they have uncorrected refractive errors. This can be exacerbated by the use of glasses that may not be the correct prescription.
- Visual Fatigue: If she reports that she cannot see clearly even with her glasses, it may be time to revisit her eye care provider. It’s essential to ensure that her glasses are providing the correct correction for her vision needs.

Conclusion
In summary, the management of amblyopia in your daughter should involve regular monitoring of her vision, appropriate adjustments to her glasses prescription based on her progress, and ensuring that her treatment regimen (including patching) is effective without causing discomfort.
If her symptoms persist or worsen, it is crucial to consult with her eye care provider to reassess her treatment plan. Early intervention and consistent follow-up are key to improving her visual outcomes and ensuring that her amblyopia is managed effectively. Always feel free to ask questions during your visits to ensure that you fully understand the treatment plan and its implications for your daughter’s vision.

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