Amblyopia: Can Vision Correction Still Help After Age Nine?

Regarding unilateral amblyopia?

I have amblyopia in one eye and I am about to move up a grade.
I have not been wearing corrective glasses until now.
Is it still possible to correct it? Many people say that after the age of nine, it becomes very difficult to correct.
Also, I would like to ask if the corrective glasses for amblyopia must be the type that cover the weaker eye.
What types of glasses are available for correcting amblyopia now? I know many people wear glasses with one side darkened; are there any glasses that do not look like they have a cover but actually prevent the eye from seeing? Can I also wear contact lenses? If amblyopia is not corrected, will the eye appear unusual? Will it gradually stop moving? Is it only because I haven't worn corrective glasses that it has become like this? I have noticed that my eye (the one with amblyopia) looks strange, and my vision seems to be around 0.3.
Please help me answer these questions.
Thank you.

Niming, 10~19 year old female. Ask Date: 2005/07/01

Dr. Liu Jingxian reply Ophthalmology

Hello Ms.
Chen,
What is "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 the absence of any pathological changes in the ocular structures.
The golden period for treating amblyopia is between the ages of 3 to 6 years.
If treatment is initiated after the age of 8 or 9, the effectiveness is usually limited.
Exploring the mechanisms behind amblyopia: During the process of visual development, the eyes and the visual cortex require adequate light and visual stimuli to develop properly.
When light enters the eye, it is refracted by the cornea, lens, and other structures, focusing the image on the retina, which then transmits the visual signals to the brain's visual centers.
During the developmental period (before the age of six), if the focusing of light on the retina is disrupted, it can lead to insufficient visual stimulation, resulting in developmental obstacles and ultimately causing amblyopia.
For example, high refractive errors (high myopia, hyperopia, or astigmatism) can prevent light from focusing correctly on the retina, potentially leading to amblyopia.
Other conditions such as strabismus, ptosis, cataracts, and corneal opacities, if they occur during this developmental period (before the age of six), can obstruct light entry into the eye and affect image focusing on the retina, which may also cause amblyopia.
There are several steps to consider in the treatment of amblyopia:
1.
Is there any refractive error? High myopia, hyperopia, astigmatism, etc., should first be corrected with glasses (according to the physician's prescription).
2.
Are there any other "occlusive eye diseases" or other ocular conditions? Conditions such as congenital cataracts, congenital ptosis, strabismus, etc., may also require surgical correction.
3.
"Occlusion therapy" involves forcing the amblyopic eye to see, typically requiring all-day occlusion therapy (the upper limit for children is generally four days a week for four-year-olds, five days for five-year-olds, and six days for six-year-olds, but adjustments should be made based on the child's actual situation).
4.
For those with poor responses to occlusion therapy, "amblyopia training" may be combined.
Based on your description, you are approximately 16 years old, and your best corrected visual acuity in the amblyopic eye is 0.3 (monocular amblyopia).
The ideal timing for correction is somewhat late.
However, it is still recommended that you wear glasses with the correct prescription to correct the amblyopic eye.
Although the degree of visual improvement may not match that of a normally functioning eye with glasses, it will still be better than not wearing glasses at all.
As for "occlusion therapy" and "amblyopia training," they are not strictly enforced.
With certain stimulation, although the visual improvement in the amblyopic eye may be limited, the appearance and functionality of the eye may appear more normal and agile.
Wishing you good health.
Dr.
Liu Jing-Hsi, Ophthalmology
Taipei City Hospital, Zhongxing Branch, Taiwan e-Learning Academy

Reply Date: 2005/07/01

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 use during early childhood. The critical period for treating amblyopia is generally considered to be before the age of nine, as the visual system is still developing. However, this does not mean that treatment is entirely ineffective after this age; it may just be more challenging and the outcomes may not be as optimal.

To address your concerns, let's break down the questions and provide some insights based on medical knowledge regarding amblyopia and its treatment options.

1. Can vision correction still help after age nine?
While it is true that the earlier amblyopia is treated, the better the chances for improvement, recent studies have shown that some degree of visual improvement can still occur in older children and even adults. Treatment may involve a combination of corrective lenses, patching the stronger eye, and vision therapy. The effectiveness of treatment after age nine can vary significantly from person to person, depending on the severity of the amblyopia and the individual's specific circumstances.

2. Is patching the only method for correcting amblyopia?
Patching is a common method used to treat amblyopia, where the stronger eye is covered to encourage the weaker eye to work harder. However, there are other options available. For instance, atropine drops can be used in the stronger eye to blur vision temporarily, which can also stimulate the weaker eye. Additionally, vision therapy exercises can help improve coordination and visual processing skills.
3. Are there discreet options for patching?
Yes, there are more discreet options available for patching. Some patches are designed to be less noticeable, such as those that can be placed on the lens of glasses. These patches can be made to look like regular sunglasses or can be tinted to blend in with the lens. There are also specialized contact lenses that can be used to occlude vision in the stronger eye without the need for a visible patch.

4. Can contact lenses be used for amblyopia treatment?
Contact lenses can be an option for individuals with amblyopia, particularly if they are more comfortable than glasses. However, the effectiveness of contact lenses in treating amblyopia depends on the specific treatment plan prescribed by an eye care professional. In some cases, contact lenses may be used in conjunction with other treatments like patching or vision therapy.

5. What happens if amblyopia is not treated?
If amblyopia is left untreated, the vision in the affected eye may not improve, and it can lead to permanent visual impairment. The brain may begin to ignore signals from the weaker eye, leading to further deterioration of vision. Additionally, untreated amblyopia can result in issues with depth perception and coordination, which can affect daily activities.

6. Will the appearance of the eye change if amblyopia is not corrected?
Over time, if amblyopia is not treated, the affected eye may appear to be misaligned or "lazy." This can lead to noticeable differences in appearance between the two eyes, which may affect self-esteem and social interactions. The eye may not move as freely as the other eye, and this can become more pronounced as the individual ages.

In conclusion, while the optimal time for treating amblyopia is during early childhood, there are still options available for individuals over the age of nine. It is essential to consult with an eye care professional who specializes in amblyopia to discuss the best treatment options tailored to your specific needs. Early intervention, even at a later age, can still yield positive results, so it is never too late to seek help.

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