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Amblyopia

Frequently Asked Questions about Amblyopia
- excerpts from American Association for Pediatric Ophthalmology and Strabismus (AAPOS) website

What is amblyopia?
Amblyopia or "lazy eye" is a common vision problem in children and is responsible for vision loss in more children than all other causes combined. Amblyopia is decreased  vision of a child that results when one or both eyes send a blurry image to the brain.  The brain does not learn to see clearly. Amblyopia may occur even when there is no observable structural abnormality of the eye. If amblyopia is not treated in a timely fashion the vision loss may be permanent into adulthood.

How is amblyopia detected?
A parent or primary care physician may notice either poor vision or strabismus.
Primary care physicians routinely screen for amblyopia. Amblyopia is sometimes detected on pre-school vision screening.

What are the types of amblyopia?
The types and causes of amblyopia are: Strabismic amblyopia, deprivation amblyopia, refractive amblyopia, or a combination of the three. All forms of amblyopia result in reduced vision in the effected eye(s).

What is strabismic amblyopia?
Strabismic amblyopia develops when the eyes are not aligned. When an eye turns in, out, up or down the brain may "turn off" the eye that is not aligned and the vision subsequently decreases.

What is deprivation amblyopia?
Deprivation amblyopia develops when a cataract or similar condition "deprives" a child's eye of visual input  If not treated very early, vision loss may be severe and may affect one or both eyes.

What is refractive amblyopia?
Refractive amblyopia occurs when a child has a large or unequal amount of refractive error (need for glasses). Usually the brain "turns off" the eye that has the larger refractive error. Parents and primary care physicians may not notice a problem because the eyes are often aligned and the good eye vision is normal. Therefore, this kind of amblyopia may not be detected unless the vision is tested.

Will glasses help a child with refractive amblyopia see better?
Sometimes, but glasses alone may not correct the vision to 20/20. Glasses are prescribed  initially and vision monitored until there is no further improvement. Any remaining amblyopia is then treated.

Can both eyes have amblyopia?
Yes. When there are equal amounts of high refractive error, both eyes may have poor vision (bilateral amblyopia) even when wearing glasses. Constant wear of glasses is very important and vision is checked frequently. Vision typically improves but may take several years.

When and how is amblyopia treated?
Amblyopia is treated during childhood.  The earlier it is treated following onset, the better the treatment result. Usually, by the age of 9-10 years, the visual system is stable and the vision does not improve much with treatment. However, vision improvement can occur up to 17 years in some cases.

The underlying cause of the amblyopia is treated (correction of refractive error with glasses or contact lenses, removal of cataract, etc) and then vision reassessed. If vision is still reduced, consideration is given to amblyopia treatment. The main forms of treatment are patches and drops. Occlusion treatment involves patching the better seeing eye to stimulate vision in the poorer seeing eye. The ophthalmologist prescribes the hours per day to patch based on the age of the child and the severity of vision deficit.  Follow-up exams assess vision in the poorer seeing eye for improvement and in the better seeing eye to confirm no decrease in vision (occlusion amblyopia).

What kind of patch should be used?
The classic patch is an adhesive "Band-Aid" type which is applied directly to the skin around the eye. These are available in different sizes, colors and designs for younger and older children. For children wearing glasses, a semi-transparent sticker placed on the lens or a cloth patched slipped onto the glasses may be utilized. "Pirate" patches on elastic bands are not recommended due to easy removal by children.


Are any specific activities recommended while patching?
No. However, performance of near activities (reading, coloring, hand-held computer games) while patching may be more stimulating to the brain and produce a quicker recovery of vision. Watching a favorite TV program or use of a computer while patching sometimes encourages compliance. Sometimes patching may be utilized at school.


What if a child refuses to wear the patch?
Many children resist wearing a patch at first. Successful patching requires persistence and much encouragement from family members, neighbors, teachers, etc. Children often throw a temper-tantrum, but eventually learn not to remove the patch. A reward to the child for successful patching can be helpful. Usually co-operation improves as the vision improves.

Is there an alternative to patching to treat amblyopia?
Sometimes the stronger eye can be "penalized" or the vision blurred to below the level of the poorer seeing eye. This can be done by using an eye drop (Atropine or Cyclogyl) to dilate the pupil in the better seeing  eye and possibly changing the glasses prescription. Ophthalmologists sometimes use this treatment for mild and moderate degrees of amblyopia. Penalizing eye drops work less well when the good eye is nearsighted.

What are appropriate goals of amblyopia treatment?
In all cases, the goal is to obtain the best possible vision in each eye. While not every child can be improved to 20/20, most can obtain a substantial improvement in vision. Realistic goals depend on the age of the child and the level of vision when the amblyopia is diagnosed. Your ophthalmologist can give you an estimate of vision potential.

How long does amblyopia treatment last?
Vision usually improves within a few weeks but optimal results may take several months and depend on the level of vision and age. Once vision has been maximized, maintenance treatment until 9-10 years of age may be required to keep the vision from regressing.

What happens if amblyopia treatment does not work?
In some cases, treatment for amblyopia may not succeed in substantially improving vision. It is a difficult decision to discontinue treatment, but sometimes that is best for both the child and family. Children who have significant amblyopia in one eye should utilize protective eyewear to protect the better seeing eye from injury. As long as the better seeing eye remains healthy, normal daily function is expected

Can surgery be performed to treat amblyopia?
No.

Where can I learn more about amblyopia research?
More information about past and ongoing clinical studies regarding amblyopia can be found at the National Eye Institute web site:
http://www.nei.nih.gov/health/amblyopia/index.asp .