Severe Amblyopia and Diplopia in a 7-Year-Old: Treatment Options

7-year-old with amblyopia of varying degrees ~ severe amblyopia in one eye + diplopia issues?

The 7-year-old patient has amblyopia with severe vision impairment in the right eye: uncorrected vision is 0.03 (after dilation - myopia of -9.00 and astigmatism of -3.00).
There is a phenomenon of double vision with the prescribed glasses.
The left eye has a visual acuity of 0 degrees with a disparity of 1000 degrees.
What treatment options are available? Can you recommend authoritative and professional ophthalmologists and optometrists in Taipei for fitting glasses (to correct amblyopia and double vision)? For general amblyopia, is it advisable to prescribe sufficient correction and gradually increase the prescription? Thank you!

zero point zero, 30~39 year old female. Ask Date: 2012/11/23

Dr. Zhuang Yamin reply Ophthalmology

Dear Mommy,
Hello! Based on the information you provided, your child is already seven years old.
Generally speaking, although the critical period for treatment has been missed, there is still room for improvement with increased effort! The treatment for amblyopia should begin with proper prescription glasses followed by appropriate occlusion therapy.
Regarding the prescription, it is advisable to prescribe the full degree at once to ensure that the image is accurately focused on the retina, which will enhance the corrective effect.

The issue of diplopia that may arise after prescribing glasses is primarily due to the unequal refractive error, where the lens for the affected eye can create a prismatic effect that displaces the image.
Additionally, the image seen through the lens in the affected eye may appear smaller.
Younger children tend to adapt to fusion more quickly, while older children may find it more challenging.
If the diplopia is solely due to image displacement, adding a slight amount of prism correction can help.
Furthermore, since your child has high refractive error, it is recommended to choose lenses from brands that offer more stable optical quality to minimize unnecessary discomfort and improve future correction outcomes.
Given that this is a more complex amblyopia issue and time is of the essence, even though there are many medical centers and teaching hospitals in the northern region, I suggest seeking treatment from a physician with experience in pediatric ophthalmology.
Wishing you and your little one safety and health!

Reply Date: 2012/11/23

More Info

Severe amblyopia, commonly known as "lazy eye," and diplopia, or double vision, can be particularly challenging in children, especially at the age of 7. The case you presented indicates that the child has significant visual impairment in the right eye, with a visual acuity of 0.03 without correction and a high degree of myopia and astigmatism. The left eye appears to have normal vision, but the presence of diplopia complicates the situation.

Understanding Amblyopia and Diplopia
Amblyopia occurs when one eye does not develop proper vision during early childhood, often due to misalignment (strabismus), significant differences in refractive error between the two eyes, or other visual impairments. In this case, the right eye's severe amblyopia suggests that it has not been able to function effectively, leading to a reliance on the left eye.

Diplopia, or double vision, can arise from various causes, including misalignment of the eyes, issues with the eye muscles, or neurological problems. In children, it may occur if the brain receives conflicting visual information from both eyes, which can happen if one eye is significantly weaker than the other.

Treatment Options
1. Corrective Lenses: The first step in managing amblyopia and diplopia is often the prescription of corrective lenses. In this case, it appears that the child has been prescribed glasses, but they are experiencing double vision. This could be due to an incorrect prescription or the need for further adjustments. It is crucial to ensure that the glasses are accurately prescribed to address both the refractive errors and the amblyopia.

2. Vision Therapy: Vision therapy is a structured program of visual activities designed to improve visual skills and processing. This may include exercises to strengthen the weaker eye, improve coordination between the eyes, and reduce diplopia. A qualified optometrist or ophthalmologist specializing in pediatric vision therapy can provide a tailored program.

3. Occlusion Therapy: This involves patching the stronger eye to force the weaker eye to work harder, thereby improving its function. This method is often effective in treating amblyopia, but it requires consistent use and monitoring by an eye care professional.

4. Surgical Options: In cases where strabismus is present, surgery may be necessary to realign the eyes. This can help reduce or eliminate diplopia and improve the overall visual function of the amblyopic eye.

5. Regular Follow-ups: Continuous monitoring by an eye care professional is essential to assess the effectiveness of the treatment and make necessary adjustments. Regular follow-ups can help track the child's progress and adapt the treatment plan as needed.

Recommendations for Specialists
For a child with severe amblyopia and diplopia, it is advisable to seek care from a pediatric ophthalmologist or an optometrist who specializes in children's vision. In Taipei, you may want to consider institutions like the Taipei Medical University Hospital or the National Taiwan University Hospital, where you can find specialists with expertise in managing complex pediatric eye conditions.

Conclusion
In summary, the treatment of severe amblyopia and diplopia in a 7-year-old requires a comprehensive approach that includes corrective lenses, potential vision therapy, and possibly occlusion therapy or surgery. It is essential to work closely with a qualified eye care professional to develop a personalized treatment plan that addresses the child's specific needs. Regular follow-ups will ensure that the treatment is effective and adjusted as necessary.

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