Pediatric Amblyopia - Lazy Eye

Dr. Irene Anteby explains visual development in children, specifically treatment and prevention of Amblyopia

(14/5/2014)


Amblyopia is the leading cause for poor eyesight among young children. Four percent of the younger population suffers from this condition.  Amblyopia causes blurry vision in one or both eyes. It is not a condition one is born with, but develops as a result of abnormal visual stimulations during the early stages of development.

 

A child born with normal eye and brain structure will develop sight based on the quality of the picture that is transmitted to the brain. If the child’s visual stimulation is blurry, distorted or unclear, the child will develop amblyopia, also called lazy eye.

 

Causes for amblyopia range from droopy eyelids, which can hide part of what a child sees, to an opaque eye lens (cataract), different focal abilities between the eyes, or strabismus. Visual development is affected when the eye continually sees an unfocused or blurry picture, slowly becoming ‘lazy’. The issue is at the brain level – the brain ceases to use the blurry eye as a reference sight, and sight in that eye gets continually worse. The most critical stage of visual development is from birth through age 10, and the younger the child, the more important the visual stimulations. The earlier the condition is diagnosed, the better it will be able to be treated. The hardest part is discovering the condition, which is difficult because children generally do not complain about the situation. They learn how to ignore the lazy eye and ‘make do’ with just using the other one. Many parents are unaware of the situation.  

 

Treatment

Treating amblyopia starts with identifying the reason behind it. Eyesight is improved based on the reason behind the amblyopia – glasses, cataract surgery or fixing strabismus. Afterwards, the brain is manipulated into using the lazy eye as a reference, by blurring the normal eye. This causes the lazy eye to work harder and the brain learns to compute a cleaner, clearer picture. Blurring the normal eye is done by administering drops or by using an eye patch. This treatment can last several months or even a number of years. It’s extremely effective and many times a full recovery can be achieved. The success rate is dependent on the age of the child when diagnosed, how severe, the reason for the lazy eye and the willingness of the family to engage in treatment.

 

Prevention

It is important to try and prevent the development of amblyopia. The best way to prevent the situation is by screening for it. Today, these screening tests are funded by the Jerusalem municipality and Hadassah and the ‘Tipat Chalav’ children’s clinics, and are performed there for children between the ages of nine months and two years. If a child does not passing the screening test at Tipat CHalav, he will be referred to a pediatric optometrist through the healthcare fund.  Additionalt screening tests are done during kindergarten. Children who do not pass this screening test are referred to an optometrist for further treatment.

 

Additionally, children who have a family history of eye problems, specifically amblyopia, should make sure they get regular eye exams, at ages one, three and before they enter first grade. Parents should know in advance that during these comprehensive eye exams, the optometrist will administer eye drops which will temporarily blur their child’s vision. Even though they are uncomfortable, drops are an extremely effective way for determining the existence of amblyopia or other serious eye conditions.

 

When should I take my child for an eye exam?

  • If your baby seems unable to focus, or cannot follow things with his eyes
  • If your child who seems cross-eyed
  • If your child has unusual eye movements, flickering or blinking
  • If your child has difficulty with fine motor skills
  • If your child is constantly getting closer to the television
  • If your child is constantly rubbing his eyes
  • If your child closes one or both eyes in direct sunlight
  • If your child has a tendency to become hyperactive, and is unable to sit and focus
  • If your child has a family history of eye conditions.

 

This information page was compiled by Dr. Irene Anteby

Director, The Center of Pediatric Opthamology