Hyperopia and Amblyopia Treatment Options for Children

Q: Hyperopia and Amblyopia Treatment Options for Children

Hello Mr. <br>Zhang： Each physician has their own approach, so please choose one doctor and follow their recommendations. <br>They will continuously adjust based on the child's vision changes, which should yield good results. <br>Listening to different opinions and constantly cha

Hyperopia and Amblyopia Glasses Prescription Issues

"Each physician has their own approach.
Please choose a physician, and based on their recommendations, they will continuously adjust according to the child's vision changes.
Therefore, there should be good results.
If it were me, I would first perform cycloplegic refraction, prescribe glasses based on the prescription, avoid occlusion initially, wear them for a period, observe the changes in vision, and then determine if occlusion is necessary."
Hello, thank you for your previous response.
I would like to ask a few more questions.

1.
Last time you mentioned that if it were you, you would perform cycloplegic refraction before prescribing glasses.
However, the doctor who does not perform cycloplegic refraction stated that hyperopia does not require cycloplegia, as it would result in a stronger prescription, and that cycloplegic refraction is only necessary for myopia, so direct refraction and prescription would suffice.
Is this due to differing opinions among physicians, leading to different treatment methods?
2.
Since cycloplegia significantly affects the prescription, what are the potential consequences of wearing glasses with an insufficient or stronger prescription?
3.
Additionally, I followed the advice of the doctor who performed cycloplegic refraction and got a pair of glasses for my child.
After about a month of wearing them, my child says they see less clearly with the glasses than without them.
What could be the reason for this?
4.
The doctor who performed cycloplegic refraction mentioned that vision changes should be observed for about six months.
Is such a long observation period necessary? You mentioned observing for a period of time; does that also require this length of time?
5.
This doctor also stated that occlusion should be done at least six days a week for five hours, and if the weaker eye does not improve, then for eight hours, meaning occlusion should be done simultaneously with wearing glasses.
I have concerns about occluding the better eye and potentially worsening its condition, so I am uncertain whether to follow this doctor's advice.
According to your perspective, should we stabilize vision or ensure improvement before starting occlusion? Would this delay treatment for the weaker eye and make it harder to treat? I am genuinely conflicted after consulting three different physicians, all with varying opinions—some contradictory, some similar.
Even Google articles provide many different explanations.
Lacking expertise in this area, I fear that taking one action may worsen another, or that not taking action may lead to regret later.
I am truly in a dilemma.
Thank you.

Mr. Zhang, 0~9 year old female. Ask Date: 2022/04/26

Dr. Gao Pilin reply Ophthalmology

Hello Mr.
Zhang: Each physician has their own approach, so please choose one doctor and follow their recommendations.
They will continuously adjust based on the child's vision changes, which should yield good results.
Listening to different opinions and constantly changing approaches may have the opposite effect.

1.
Each physician has different insights, leading to different methods.
As long as the results are good, any method can be accepted.

2.
Dilation refers to the degree of relaxation of the ciliary muscle, while non-dilated vision is the normal degree.
Both can achieve the correction of amblyopia.

3.
The reason is that the child has become accustomed to straining their eyes and cannot relax.
Therefore, the vision during dilation may appear unclear.
However, after a period of time, once they get used to relaxing, their vision will become clearer.

4.
As long as the child wears glasses, their eyes will gradually develop.
The changes in vision can vary from person to person, so continuous monitoring is necessary; improvement may occur within a month.

5.
Since the child is not wearing an eye patch all day, when the eye is not covered, the good eye can still see, so it will not worsen.
Please rest assured.
In summary, following the same physician's approach and trusting them while maintaining regular follow-ups is better for the child.

Reply Date: 2022/04/26

More Info

Understanding hyperopia (farsightedness) and amblyopia (lazy eye) in children can be quite complex, especially when navigating various treatment options and differing opinions from healthcare professionals. Let's break down your questions and concerns systematically.

1. Differences in Treatment Approaches: The disagreement between doctors regarding the necessity of cycloplegic refraction (using eye drops to temporarily paralyze the eye's focusing muscles) often stems from differing philosophies and experiences. Some practitioners believe that cycloplegic refraction is essential for accurately determining the true refractive error, particularly in children, as it helps to eliminate the influence of accommodation (the eye's ability to focus). Others may argue that for hyperopia, especially if it's mild, cycloplegic refraction may not be necessary. Ultimately, the choice of method can depend on the individual child's needs and the doctor's clinical judgment.

2. Impact of Incorrect Prescription: Wearing glasses with an incorrect prescription can lead to several issues. If the prescription is too strong, it may cause discomfort, headaches, or visual distortion. Conversely, if the prescription is too weak, the child may struggle to see clearly, which can hinder their visual development and potentially exacerbate amblyopia. It’s crucial to ensure that the prescription is accurate to support the child's visual needs.

3. Complaints of Blurriness: If your child feels that their vision is clearer without glasses, it could indicate that the prescription is not appropriate for their current visual needs. This could be due to an overcorrection or undercorrection of their refractive error. It’s essential to revisit the prescribing doctor to reassess the prescription and ensure it aligns with the child's actual visual acuity.

4. Observation Period for Vision Changes: The recommendation to observe vision changes over six months is not uncommon, especially in pediatric ophthalmology. Vision can take time to stabilize and improve, particularly when adjusting to new glasses or treatment protocols. However, if there are concerns about the effectiveness of the treatment or if the child is experiencing difficulties, it is reasonable to seek a follow-up appointment sooner than the suggested timeframe.

5. Occlusion Therapy (Eye Patching): The approach to occlusion therapy can vary significantly among practitioners. While some may advocate for aggressive patching to encourage the weaker eye to strengthen, others may recommend a more gradual approach, especially if there are concerns about the stronger eye deteriorating. It’s important to balance the need to treat amblyopia with the risk of negatively impacting the better-seeing eye. If you have concerns about the patching regimen, discussing these with the prescribing doctor is vital. They can provide guidance tailored to your child's specific situation.

In summary, navigating the treatment of hyperopia and amblyopia in children requires careful consideration and often involves trial and error. It’s essential to maintain open communication with your child's eye care provider, express your concerns, and seek clarity on any conflicting advice. Regular follow-ups and assessments will help ensure that your child receives the most appropriate care for their visual development. If you feel uncertain about the current treatment plan, seeking a second opinion from another pediatric ophthalmologist may also provide additional insights and reassurance.

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