Serious Amblyopia in Three-Year-Old: Seeking Effective Treatment Options

A three-year-old child has severe amblyopia?

I would like to ask the doctor, my child is already three years old.
Last year, we discovered that he has amblyopia, and despite receiving treatment at the hospital until this year, the condition has worsened.
He currently wears glasses with over 1000 diopters, yet he still has difficulty seeing.
What should we do? Due to his vision problems, he has been unable to concentrate.
We regularly visit the hospital (Chang Gung Memorial Hospital) for treatment and correction, but there has been no improvement; in fact, his prescription has become stronger.
If we consider traditional Chinese medicine treatment, would it be effective? Or are there other better medical teams or doctors you could recommend? My child's vision has deteriorated to the point where he is almost unable to see, and I am very concerned that if we continue to delay, he may lose his sight completely.
I hope the doctor can help us and assist us in finding a treatment direction as soon as possible.
A worried mother.

Youying de mama, 30~39 year old female. Ask Date: 2005/02/02

Dr. Liu Jingxian reply Ophthalmology

Dear Concerned Mother,
Regarding your questions, here are the answers:
1.
Amblyopia: Amblyopia refers to a condition where, after the normal developmental period of the eyes, one or both eyes cannot achieve the best corrected visual acuity of 0.8 or above with glasses, despite no pathological changes in the eye structures.
The golden period for treating amblyopia is between the ages of 3 to 6 years.
If treatment begins after the age of 8 to 9, the effectiveness is usually limited.
2.
Therefore, there are "visual milestones" to follow in the development of children's vision:
- At age 3: 0.5
- At age 4: 0.6
- At age 5: 0.7
- At age 6: 0.8
If your 4-year-old child achieves a best corrected vision of 0.6 with glasses, this is considered normal for their age.
3.
There are several steps to consider in the treatment of amblyopia:
- Is there any refractive error? Conditions such as high myopia, hyperopia, or astigmatism need to be corrected first with glasses (as prescribed by a physician).
- Are there any other occlusive eye diseases or other eye conditions? For example, congenital cataracts, congenital ptosis, or strabismus may require surgical correction.
- Occlusion therapy: This involves forcing the amblyopic eye to see, typically requiring all-day patching (the upper limit for patching in young children is four days a week for a 4-year-old and five days a week for a 5-year-old, but adjustments should be made based on the child's actual situation).
- For those with poor responses to occlusion therapy, amblyopia training may be combined.
4.
The above treatments primarily focus on children aged 3 to 6 years with amblyopia.
5.
Based on your description, your child's condition appears to be due to high myopia leading to poor vision.
Starting correction at this age is appropriate.
With patience in identifying the underlying cause and effective communication with your child for treatment cooperation, improvement should be expected.
As for the efficacy of traditional Chinese medicine, there is currently no definitive conclusion.
If you have further concerns, please feel free to reach out again.
Wishing you good health,
Ophthalmology Attending Physician
Liu Jing-Chih
Taipei City Hospital, Zhongxing Branch
Taiwan e-Learning Academy

Reply Date: 2005/02/02

More Info

Amblyopia, commonly referred to as "lazy eye," is a condition where one eye does not develop proper vision, leading to reduced visual acuity that cannot be corrected by glasses or contact lenses. In children, early detection and intervention are crucial for effective treatment, especially before the age of 8, as the visual system is still developing. Given that your child is three years old and has been diagnosed with significant amblyopia, it is understandable that you are concerned about the worsening condition despite corrective measures.

The first step in treating amblyopia typically involves addressing any underlying issues, such as refractive errors (nearsightedness, farsightedness, or astigmatism). In your child's case, wearing glasses with a prescription of over 1000 degrees indicates a significant refractive error that needs to be corrected. However, simply wearing glasses may not be sufficient to treat amblyopia, especially if the condition is severe.

Standard treatment options for amblyopia include:
1. Occlusion Therapy: This involves patching the stronger eye to force the weaker eye to work harder. The duration and frequency of patching depend on the severity of amblyopia and the age of the child. Consistent adherence to this treatment is essential for improvement.

2. Atropine Drops: In some cases, atropine drops may be used in the stronger eye to blur vision, encouraging the weaker eye to strengthen. This method can be an alternative to patching, especially for children who resist wearing a patch.

3. Vision Therapy: This is a structured program of visual activities designed to improve visual skills and processing. It may include exercises to enhance eye coordination, focusing, and visual perception.

4. Surgery: In certain cases, if there are anatomical issues such as strabismus (crossed eyes), surgical intervention may be necessary to align the eyes properly.

Given that your child has been undergoing treatment without significant improvement, it may be beneficial to seek a second opinion from a pediatric ophthalmologist who specializes in amblyopia. They can assess your child's condition comprehensively and may suggest alternative treatment options or adjustments to the current regimen.

As for considering traditional Chinese medicine (TCM), while some parents explore TCM for various health issues, the efficacy of such treatments for amblyopia is not well-established in scientific literature. It is essential to approach TCM with caution and consult with a qualified practitioner who understands both TCM and conventional ophthalmology.
In addition to seeking further medical advice, ensure that your child is engaged in activities that promote visual development, such as reading, drawing, and playing with toys that require focusing and eye-hand coordination.
Lastly, it is crucial to maintain regular follow-ups with your ophthalmologist to monitor your child's progress and make necessary adjustments to the treatment plan. Early and aggressive treatment is key to improving outcomes in amblyopia, so addressing this issue promptly is vital for your child's visual development and overall quality of life.

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