Amblyopia Treatment: Key Questions Answered by an Expert

Amblyopia correction

Hello Dr.
Chuang, I have a few questions regarding amblyopia correction:
1.
Is it better to correct with glasses that fully address hyperopia? Would reducing the prescription by 50 diopters affect the correction?
2.
What is the difference between patching one eye for 4 hours versus 6 hours?
3.
Can excessive patching of one eye affect the normal eye?
4.
Is it normal for the amblyopic eye to exhibit head tilt or strabismus while looking at objects during patching? Is this related to insufficient hyperopia correction?
5.
I visited two clinics; the first used a cycloplegic agent and diagnosed hyperopia at 200 diopters, while the second did not use a cycloplegic agent and diagnosed over 300 diopters.
How can this discrepancy occur?
6.
The first clinic reduced the prescription by 50 diopters to 150 diopters, fearing the child might not adapt well.
After a month, I consulted the second clinic, which diagnosed over 300 diopters.
The doctor questioned how the first clinic could reduce the prescription so much.
The current glasses allow the child to see 0.5, but with a stronger prescription, the child can see 0.8.
What does the doctor mean by "correctable vision"? Since the glasses were just prescribed a month ago, should we consider getting a higher prescription for correction? Thank you for your answers.

kiwi, 30~39 year old female. Ask Date: 2013/04/22

Dr. Zhuang Yamin reply Ophthalmology

Dear Kiwi,
Regarding the questions you raised, here are the answers:
1.
Is it better to correct with glasses that match the full hyperopia prescription? --> If the prescription was obtained after "appropriate" dilation, then using the full prescription will provide better correction.
2.
What is the difference between covering one eye for 4 hours versus 6 hours?
3.
Does excessive occlusion of one eye affect the normal eye? --> Generally, the longer the occlusion, the better the correction effect for the amblyopic eye; however, excessive occlusion of the normal eye can lead to a decrease in vision in that eye, and this phenomenon is more pronounced in younger children.
Therefore, the duration of occlusion is usually adjusted based on the child's age, the degree of amblyopia, the disparity in visual acuity between the two eyes, and the child's cooperation.
4.
Is it normal for the amblyopic eye to exhibit head tilt or strabismus while looking at things during occlusion? --> This phenomenon is more common when the amblyopic eye is still in a state of refractive error or when the occlusion is not complete (e.g., the child tries to peek through the edges of the occluder).
5.
I visited two clinics; the first used a dilating agent and assessed hyperopia at 200 degrees, while the second did not use a dilating agent and assessed hyperopia at over 300 degrees.
How can this happen? --> Theoretically, the hyperopia measured after dilation should be higher.
If this discrepancy is not due to instrument error, it may indicate that the child's ciliary muscle is in a state of excessive spasm.
For accurate measurement, adjustments should be made to the medication and preparation before the examination.
6.
The first clinic reduced the prescription by 50 degrees, providing glasses with a prescription of 150 degrees, fearing that the child might not adapt initially.
After a month, I consulted the second clinic, which assessed hyperopia at over 300 degrees.
The doctor questioned how the first clinic could reduce the prescription so much.
The doctor mentioned that with the current glasses, the child could see 0.5 during the vision test, but with a higher prescription, the child could see 0.8.
What does the doctor mean by "potential acuity"? Since the glasses were just fitted a month ago, should I get a new pair with a higher prescription? --> Accurate prescription is crucial for the correction of amblyopia.
Based on personal experience, I still recommend using the full prescription! I suggest confirming the prescription before getting new glasses.
Wishing you good health!

Reply Date: 2013/04/22

More Info

Amblyopia, commonly known as "lazy eye," is a visual development disorder where one eye fails to achieve normal visual acuity, typically due to a lack of visual stimulation during early childhood. Treatment for amblyopia is crucial, as it can lead to permanent vision impairment if not addressed. Here, I will address your questions regarding the treatment of amblyopia, particularly focusing on the use of corrective lenses, patching therapy, and the importance of accurate prescriptions.

1. Corrective Lenses for Hyperopia: Using the appropriate prescription glasses is essential for treating amblyopia, especially in cases of hyperopia (farsightedness). Correcting hyperopia with the full prescription can help improve visual acuity in the amblyopic eye. If the prescription is reduced by 50 degrees, it may not provide sufficient visual stimulation, potentially hindering the treatment process. The goal is to ensure that the amblyopic eye receives adequate visual input to develop properly. Therefore, it is generally recommended to use the full prescription unless otherwise advised by an eye care professional.

2. Patching Duration: The duration of patching therapy can vary based on the severity of amblyopia and the age of the child. Patching for 4 hours versus 6 hours can have different impacts on treatment efficacy. Longer patching times may lead to more significant improvements in visual acuity, but they can also cause discomfort and fatigue. The key is to find a balance that maximizes treatment benefits while minimizing discomfort. Regular follow-ups with an eye care specialist are essential to monitor progress and adjust the treatment plan as needed.

3. Impact on the Normal Eye: Patching the amblyopic eye can sometimes lead to temporary visual disturbances in the normal eye, particularly if the patching is excessive or not properly managed. However, when done correctly, patching should not adversely affect the vision of the normal eye. It is crucial to follow the prescribed patching schedule and to have regular check-ups to ensure that both eyes are developing appropriately.

4. Head Tilting and Strabismus: It is not uncommon for children with amblyopia to exhibit head tilting or squinting, especially when they are trying to see clearly with the amblyopic eye. This behavior can be related to uncorrected refractive errors, such as hyperopia. If the glasses prescription is inadequate, it may exacerbate these symptoms. Addressing the refractive error with the correct prescription can help alleviate these issues.

5. Discrepancies in Refraction Results: Differences in refraction results between clinics can occur due to various factors, including the use of cycloplegic agents (like dilating drops) during the examination. Cycloplegic refraction provides a more accurate assessment of the eye's refractive error by temporarily paralyzing the ciliary muscle, preventing accommodation (the eye's ability to focus). If one clinic used cycloplegic drops and the other did not, this could explain the discrepancy in the measured hyperopia.

6. Adjusting Prescription: If the first clinic prescribed a lower degree of correction and the second clinic indicated a higher degree, it is essential to consider the child's comfort and visual performance with the current glasses. If the child is achieving better vision with the higher prescription, it may be beneficial to adjust the glasses accordingly. Regular follow-ups are crucial to ensure that the child is receiving the most appropriate treatment for their amblyopia.

In summary, the treatment of amblyopia requires a comprehensive approach that includes the correct use of glasses, appropriate patching therapy, and regular monitoring by an eye care professional. Each child's situation is unique, and treatment plans should be tailored to their specific needs. If there are any concerns about the effectiveness of the current treatment or the child's visual development, it is advisable to consult with an eye specialist for further evaluation and guidance.

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