Amblyopia: Concerns and Progress in Children's Vision Treatment

Amblyopia

Dr.
Wu: Hello, my child was diagnosed with severe amblyopia in one eye (around 1400 degrees) at the age of four years and eleven months.
We have been patching the eye every day from 8:00 AM to 9:00 PM (six days a week, with one day without glasses and no patching).
On Saturdays, we go to the hospital for half an hour to draw rotating figures.
Now, at five years and eight months, there has been no improvement (the doctor has increased the prescription from -1250 in the left eye to -1400, and from no prescription in the right eye to -150 for myopia and astigmatism).
Currently, with glasses, the left eye can see 0.3-0.4.
My questions are: 1.
Why is there no improvement in vision and it seems to be getting worse? Where is the problem in the process? 2.
My doctor is very good and says the child is making progress, so why are the glasses prescriptions getting stronger? 3.
What is the potential for improvement for my child? 4.
Is it okay for my child to watch TV for about 40 minutes in the morning and evening without patching or wearing glasses? 5.
Will my child have any long-term effects due to the significant difference in vision when they reach adulthood? An anxious mother, thank you for your response.

Danxin de mama, 30~39 year old female. Ask Date: 2005/07/18

Dr. Liu Jingxian reply Ophthalmology

Dear Concerned Mother,
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 eye 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 to 9 years, the effectiveness is usually limited.
The developmental process of children's vision has certain "visual milestones," with the minimum requirements being: 0.5 for a three-year-old; 0.6 for a four-year-old; 0.7 for a five-year-old; and 0.8 for a six-year-old.
To explore the mechanisms behind the occurrence of amblyopia in children: during the visual development process, the eyes and the visual cortex need to receive adequate light and visual stimuli to develop properly.
When light enters the eye, it is refracted by the cornea, lens, etc., focusing the image on the retina, which then stimulates the retina to transmit the image signals to the brain's visual centers.
If, during the developmental period (before the age of six), the focusing of light on the retina is disrupted, it can lead to insufficient visual stimulation, creating obstacles to visual development and resulting in amblyopia.
For example, high refractive errors (high myopia, hyperopia, or astigmatism) can prevent light from focusing correctly on the retina, potentially causing 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 from entering the eye and focusing on the retina, which may also lead to 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 eye conditions? For instance, congenital cataracts, congenital ptosis, strabismus, etc., may require surgical correction.
3.
"Occlusion therapy" involves forcing the amblyopic eye to see, typically requiring all-day occlusion therapy (the upper limit for occlusion therapy for children is four days a week for a four-year-old, five days for a five-year-old, and six days for a six-year-old, but adjustments should be made based on the child's actual situation).
4.
For those with poorer treatment outcomes, "amblyopia training" can be combined.
Based on your description, your child has developed unilateral amblyopia due to high myopia.
The first step is to wear glasses with the correct prescription (children usually adapt well and do not have issues with wearing them, but may resist wearing them): myopia of -1400 degrees and astigmatism of -300 degrees.
The second step is "occlusion therapy," which should be "all-day occlusion therapy," except during sleep.
Your child is currently about 5 years and 9 months old, and according to the six-year standard, the upper limit for occlusion therapy is six days a week (exceeding this may affect the normal eye).
The third step is "amblyopia training," which involves visiting the hospital once a week for corrective exercises.
Additionally, you can increase self-training time by finding engaging activities, such as watching cartoons (watching TV is a good "amblyopia training" method, and glasses should be worn during occlusion therapy), playing computer games, using video game consoles, playing with challenging building blocks, or providing coloring books for daily drawing.
It is essential to engage your child's attention and force the amblyopic eye to see; this type of training should yield more significant results.
If the vision in the amblyopic eye can be corrected, children at this age typically adapt well to the disparity.
Wishing you health,
Dr.
Liu Jing-Hsiu
Ophthalmology
Taipei City Hospital, Zhongxing Branch
Taiwan e-Learning Academy

Reply Date: 2005/07/18

More Info

Amblyopia, commonly known as "lazy eye," is a condition where one eye fails to achieve normal visual acuity, even with the use of glasses or contact lenses. It typically develops in childhood and can be caused by various factors, including strabismus (misalignment of the eyes), significant differences in refractive error between the two eyes, or other visual impairments. Your concerns regarding your child's amblyopia treatment are valid, especially given the complexity of managing this condition.

1. Lack of Improvement: The absence of improvement in your child's vision, despite consistent treatment, can be attributed to several factors. Amblyopia treatment is most effective when initiated at a young age, ideally before the age of 7. Since your child is now over five years old, the window for optimal treatment is narrowing. Additionally, the severity of the initial amblyopia (in this case, a significant refractive error) can impact the potential for improvement. If the underlying cause of amblyopia, such as strabismus or significant refractive differences, is not adequately addressed, it may hinder progress.

2. Increasing Prescription: The increase in your child's glasses prescription could indicate that the amblyopic eye is not developing properly. This could be due to insufficient stimulation of that eye, leading to a worsening of its visual acuity. It is crucial to ensure that the amblyopic eye is being used effectively during treatment. If the child is not wearing the glasses consistently or if the occlusion (patching) is not being done correctly, it may lead to a decline in vision.

3. Potential for Improvement: While the potential for improvement decreases with age, it is not entirely lost. Children can still experience gains in visual acuity with appropriate treatment, even if they are older than the ideal age for intervention. The key is to maintain a consistent and effective treatment regimen, which may include continued patching, vision therapy, and regular follow-ups with an eye care professional.

4. Screen Time Considerations: Allowing your child to watch television without their glasses or patching may not be advisable. While some visual stimulation is beneficial, it is essential that the amblyopic eye is being actively engaged during treatment. Screen time should ideally be limited to ensure that the child is using their glasses and following the prescribed treatment plan.

5. Long-term Effects: If the disparity in vision between the two eyes persists into adulthood, it can lead to complications such as depth perception issues or difficulties with visual tasks that require binocular vision. It is crucial to address amblyopia early to minimize these risks.

In summary, it is essential to maintain open communication with your child's eye care provider. Regular follow-ups and adherence to the treatment plan are critical for managing amblyopia effectively. If you feel that your child's progress is stagnant, consider seeking a second opinion from a pediatric ophthalmologist who specializes in amblyopia treatment. They may offer additional insights or alternative treatment options that could benefit your child. Remember, early and consistent intervention is key to improving visual outcomes in children with amblyopia.

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