Amblyopia: Choosing the Right Prescription for Your Child

Amblyopia-related

Hello, Doctor.
I have a question regarding my five-year-old child.
We went to Clinic A for a vision check, where they used a mild dilating agent.
The assessment showed that the right eye is normal, while the left eye has hyperopia of 200 degrees, which is classified as anisometropic amblyopia.
The doctor suggested not prescribing the full prescription for glasses due to concerns about my child's adaptation, recommending only 150 degrees instead.
During patching therapy, my child often squints with the left eye, raising concerns about potential strabismus.
I then sought a second opinion at Clinic B.
After examination, they found no strabismus, but they did not use a dilating agent.
They measured the left eye's hyperopia to be over 300 degrees, and the right eye also showed mild hyperopia.
I am confused about the significant discrepancies in measurements from the machines.
Which doctor's assessment should I trust? Additionally, Doctor B mentioned that with the current glasses, my child's vision reaches 0.5, but after increasing the prescription during the exam, my child could see 0.8.
Since my child has only been wearing the glasses from Clinic A for a month and has been compliant with wearing them all day, would it be more beneficial for my child's amblyopia treatment if I were to get a stronger prescription at Clinic B now? Thank you for your response.

Mandy, 0~9 year old female. Ask Date: 2013/04/20

Dr. Zhuang Yamin reply Ophthalmology

Dear Mandy,
In theory, the degree of hyperopia measured after instilling cycloplegic agents should be higher and relatively more accurate.
However, it is also important to consider whether the ciliary muscle has reached a fully relaxed state after the drops, as well as potential measurement errors from the equipment.

When it comes to amblyopia correction, it is crucial to ensure that the lens prescription is as accurate as possible to maintain the child's vision at its best state.
Regarding the issue of the left eye appearing to be misaligned, it may not necessarily be due to strabismus; it could also be caused by insufficient prescription strength.

I recommend that you conduct a complete examination again before deciding whether to adjust the lens prescription.
Wishing you good health!
Changhua Hospital

Reply Date: 2013/04/20

More Info

Amblyopia, commonly known as "lazy eye," is a condition that affects vision in one or both eyes, often due to a lack of proper visual stimulation during early childhood. In your case, your five-year-old child has been diagnosed with amblyopia in the left eye, which is hyperopic (farsighted) by 200 degrees, and the eye doctor at A clinic recommended a lower prescription of 150 degrees to ease your child into wearing glasses. This approach is not uncommon, especially when considering the potential discomfort and adjustment period for young children.

The discrepancy in measurements between the two clinics can be attributed to several factors. First, the use of a cycloplegic agent (like a dilating eye drop) during the examination at A clinic allows for a more accurate assessment of the refractive error by temporarily paralyzing the ciliary muscle, which controls the eye's ability to focus. Without this, as in the case of B clinic, the measurements can be less reliable, especially in young children who may not fully cooperate during the exam. This can lead to variations in the recorded prescription, as the child may be using their focusing ability to compensate for the refractive error, resulting in an underestimation of the true hyperopia.

When it comes to the question of which prescription to trust, it is essential to consider the context of each examination. The prescription from A clinic, taken with the cycloplegic drops, is likely more accurate. However, the fact that B clinic found a higher degree of hyperopia (over 300 degrees) without dilation suggests that there may be a significant refractive error that needs to be addressed.
As for the concern about strabismus (crossed eyes), it is important to monitor your child closely. The eye's tendency to turn in while focusing on objects can indicate a developing strabismus, especially in the context of amblyopia. Regular follow-ups with an eye care professional are crucial to ensure that any signs of strabismus are caught early and managed appropriately.

Regarding the prescription strength, if your child is currently wearing glasses with a prescription of 150 degrees and is achieving a visual acuity of 0.5, it may be beneficial to consider the higher prescription of 300 degrees if it can help improve visual acuity further. The goal of treatment for amblyopia is to ensure that the brain receives clear images from both eyes, which can help in developing normal binocular vision. If the higher prescription allows for better visual acuity (0.8), it could indeed be more beneficial for your child's amblyopia treatment.

In summary, it is advisable to consult with a pediatric ophthalmologist who specializes in amblyopia for a comprehensive evaluation. They can provide guidance on the appropriate prescription and treatment plan tailored to your child's needs. Regular follow-ups and adherence to the prescribed treatment, including patching if recommended, are essential for the best possible outcome in managing amblyopia.

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