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Amblyopia
May 24, 2020
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Amblyopia, also called lazy eye, is a disorder of sight in which the brain fails to process inputs from one eye and over time favors the other eye. It results in decreased vision in an eye that otherwise typically appears normal.
Diagnosis
A lazy eye ideally needs to be diagnosed and treated as early as possible, preferably before a child is 6 years of age.
However, it can often be difficult to know whether a child has a lazy eye as they might not realise anything is wrong with their vision.
This means a lazy eye may not be diagnosed until a child has their first eye test.
If an eye specialist suspects a lazy eye, they'll also test for other conditions, such as a squint.
Visit your GP or tell your health visitor if you have any concerns about your child's eyesight at any stage.
You can also take your child to a high-street optician, where they'll be seen by an optometrist (a specially trained optician).
Routine eye tests
Your baby's eyes will be examined within 72 hours of birth. This simple examination is used to check for obvious physical problems, such as a cataract.
Your baby will have a second eye examination when they're between 6 and 8 weeks old.
A child's vision should develop in the following way over the first year of life:
- by 6-8 weeks old – follows a bright or interesting object, such as a face, with their eyes
- by 2-3 months old – shows interest in nearby objects
- by 6 months old – focuses on objects that are both near and far away and is interested in pictures
- by 12 months old – able to see small objects, such as tiny bits of food and bits of fluff, is also able to recognise familiar people
Shortly before or after having a baby, all new parents are given a Personal Child Health Record (red book), which highlights developmental milestones for vision.
When your child is around 1 or 2 years old, you may be asked whether you have any concerns about their eyesight during a review of their health and development.
If necessary, specific eye tests that check for vision problems can be arranged.
Your child's vision may also be tested when they start school, at around 4 or 5 years of age. This will be organised by your local council.
Treatment
The younger the child is when a lazy eye is diagnosed, the more successful treatment is likely to be. Treatment is less successful if it's started after the age of 6, and it's unlikely to be successful if it's started after the age of 8.
The 2 main treatment options for a lazy eye are:
- treating or correcting any underlying eye problems
- encouraging the use of the affected eye so vision can develop properly
Treating underlying eye problems
Glasses
Short- or long-sightedness, can be corrected using glasses. These usually need to be worn constantly and checked regularly.
Glasses may also help to straighten a squint, and in some cases can fix the lazy eye without the need for further treatment.
Your child may say they can see better without their glasses. This is because their eyes have become used to working hard to focus and they now find it difficult to let the glasses focus for them.
They'll need plenty of encouragement to wear their glasses continuously.
Contact lenses are an alternative to glasses, but they may only be suitable for older children.
Surgery
In children, most cataracts are removed to allow better development of vision in the affected eye.
Cataract surgery for children is carried out under general anaesthetic. The procedure usually takes 1 to 2 hours.
Your child may be kept in hospital overnight to check their recovery, and will have to use eyedrops afterwards.
In some cases, surgery is used to improve the appearance of a squint. The operation will either strengthen or weaken the eye muscles of the lazy eye to change its position.
This means the lazy eye will appear to be better aligned with the good eye. The child's vision won't improve, but their eyes will appear straighter and it will help the eyes work better together.
A droopy eyelid can also be corrected using surgery.
Encouraging use of a lazy eye
A number of different treatment options can be used to encourage your child to use the affected eye.
Using a patch
This involves placing a patch with a sticky rim over the "good" eye so the lazy eye is forced to work. It can be very effective in improving the sight in the lazy eye. Patches often need to be worn with glasses.
The length of time the child will need to wear the patch will depend on how old they are, how serious the problem is, and how much they co-operate with wearing the patch.
Patches are most effective before a child reaches 6 years of age. Most children will need to wear the patch for a few hours a day for several months.
Using a patch to treat a lazy eye can be time-consuming and can often be an unpleasant experience for the child until they get used to it. This is understandable – from their point of view, you're making their vision worse by taking their good eye away from them.
This is why the most important thing for you to do is explain the reasons for using a patch, and the importance of sticking with the treatment, to your child so that they're motivated to do it.
If your child is too young to understand, try to think of incentives to encourage them to use the patch. While the patch is on, they should do close-up activities, such as playing with an electronic tablet, colouring, reading or schoolwork. Reward them with their favourite television programme.
Eyedrops
Atropine eyedrops can be used to blur the vision in the good eye. They expand (dilate) the pupil of the good eye and blur vision, which encourages the child to use the lazy eye.
Side effects that can occur after using eyedrops include:
- eye irritation
- reddening (flushing) of the skin
- headaches
However, these side effects are usually rare and rarely outweigh the benefits of using eyedrops.
Eyedrops can be as effective as using a patch. Often the choice of eyedrops or patches is a matter of preference. Children who do not like having drops in their eyes can wear a patch, and those who do not like wearing a patch can use eyedrops.
If treatment does not work
In some cases, a lazy eye does not improve despite having proper treatment.
Sometimes poor results are due to the child or family finding it difficult to stick to using the patch or the eyedrops.
If you're having trouble with one kind of treatment, discuss the alternatives with your eye specialist.
If surgery is recommended, more than one operation may be required to improve the appearance of a squint, and glasses may still need to be worn after surgery.
If the treatment is stopped too soon, any improvements in the lazy eye can be lost. A patch may also need to be worn or eyedrops used, if the lazy eye returns.