Effective Strategies for Treating Amblyopia in Young Children - Ophthalmology

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The issue of amblyopia in young children?


Hello Dr.
Liu: My daughter has just turned four years old.
After examination, it was found that she has astigmatism of 175 degrees in both eyes, and her vision test shows she can only see 0.4.
The doctor said this is congenital amblyopia, and she needs to wear glasses.
She will undergo patching therapy for four hours a day, alternating between eyes every other day.
The doctor mentioned that during patching, she should engage in fine motor activities, and that outdoor play or large activities would be less effective.
My daughter’s kindergarten has most of its morning activities outdoors and a significant portion of the afternoon is nap time, which seems to reduce the effectiveness of the patching therapy.
I saw your response about "amblyopia training," which can actually be done at home! It involves finding things that truly capture her attention, including watching cartoons (watching TV is a great form of amblyopia training, and she should wear her glasses during patching therapy), playing computer games, using video game consoles, engaging with more challenging building blocks, and buying coloring books for her to draw every day.
It is essential to attract her attention and encourage her to use her weaker eye.
This type of training should yield more significant results.
Therefore, I plan to utilize the time after school at four o'clock for patching therapy, accompanying her in reading, watching TV, and drawing, with a one-minute break every thirty minutes until reaching four hours.
Is this approach feasible for the daily four-hour patching therapy? Thank you.

Xin teng de mama, 30~39 year old female. Ask Date: 2006/09/09

Dr. Liu Jingxian reply Ophthalmology


Hello, Miss: There are several steps to consider in the treatment of amblyopia:
1.
Is there any refractive error present? Conditions such as high myopia, hyperopia, or astigmatism need to be corrected first with glasses (according to the physician's prescription).
2.
Are there any other occlusive eye diseases or other ocular conditions? For example, congenital cataracts, congenital ptosis, or strabismus may also require surgical correction.
3.
"Occlusion therapy" involves forcing the amblyopic eye to see, typically requiring all-day patching (the general age limit for patching therapy in children is four years, with four days a week for four-year-olds, five days a week for five-year-olds, and six days a week for six-year-olds, but adjustments should be made based on the child's actual situation, as it is not a one-size-fits-all approach).
4.
For those with poorer treatment outcomes, "amblyopia training" can be combined.
Adequate time for occlusion therapy is necessary to provide sufficient stimulation to the under-stimulated eye, leading to significant improvements in the child's vision.
If you have any further questions, you can bring your child to the ophthalmology department of the hospital for further evaluation to determine if there are other issues that could improve your child's amblyopia.
Wishing you good health,
Dr.
Liu Jing-Hsiang,
Ophthalmology, Taipei City Hospital, Zhongxing Branch

Reply Date: 2006/09/09

More Info


Amblyopia, commonly referred to as "lazy eye," is a condition that affects vision in one or both eyes, typically due to a lack of proper visual stimulation during early childhood. The treatment for amblyopia often involves a combination of corrective lenses, patching therapy, and vision exercises. In your case, your four-year-old daughter has been diagnosed with amblyopia and prescribed glasses along with an eye patching regimen.
The primary goal of patching therapy is to encourage the weaker eye to work harder, thereby improving its visual acuity. The recommendation to patch for four hours daily, alternating between eyes, is a standard approach. However, as you noted, the effectiveness of this treatment can be influenced by the child's daily activities, especially if they spend a significant amount of time outdoors or napping during the day.

To enhance the effectiveness of the patching therapy, it is crucial to engage your daughter in activities that require her to use her weaker eye. This can include watching television, playing video games, or engaging in fine motor activities like drawing or building with blocks. These activities should be enjoyable and stimulating to maintain her interest and motivation.
Your plan to utilize the time after school for patching therapy is a sound strategy. Here are some effective strategies you can implement to maximize the benefits of the patching treatment:
1. Structured Routine: Establish a consistent routine for patching therapy. For instance, after school, set aside specific times for her to wear the patch while engaging in activities that require visual focus. This could be reading books, doing puzzles, or playing games that involve hand-eye coordination.

2. Interactive Activities: Choose activities that are interactive and require her to concentrate visually. For example, arts and crafts, where she can draw or paint, can be particularly beneficial. You can also consider using educational apps or games that promote visual skills.

3. Frequent Breaks: As you mentioned, taking breaks every 30 minutes is a good practice. This helps prevent fatigue and keeps her engaged. During these breaks, you can encourage her to switch tasks or do something different to maintain her interest.

4. Positive Reinforcement: Encourage her by celebrating small achievements during her therapy sessions. Positive reinforcement can motivate her to participate actively in her treatment.

5. Monitor Progress: Keep track of her progress and any changes in her vision. Regular follow-ups with her eye care professional are essential to assess the effectiveness of the treatment and make any necessary adjustments.

6. Limit Distractions: While outdoor play is important for overall development, try to limit distractions during patching time. Create a conducive environment for her to focus on the tasks at hand.

7. Incorporate Play: Make the therapy feel less like a chore. Incorporate games that require her to use her weaker eye, such as catching a ball or playing catch with a friend while wearing the patch.

8. Consult with Professionals: Regularly consult with your eye care provider to ensure that the treatment plan is effective and to discuss any concerns you may have regarding her progress.

In conclusion, your approach to combining patching therapy with engaging activities is a practical and effective strategy for treating amblyopia. By creating a structured routine, incorporating interactive activities, and providing positive reinforcement, you can help your daughter improve her vision while making the process enjoyable. Remember, consistency is key, and regular follow-ups with her eye care professional will ensure that she is on the right path to recovery.

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