Amblyopia: Your Child Could Be Going Blind without you knowing it.
Jul 01 '09 (Updated Jul 09 '09)
The Bottom Line All children need routine vision screening to rule out Amblyopia.
Your Child Could Be Going Blind without you knowing it.
.. Mine was.
My world changed in February 2009 when I received a report from the school vision screening that my daughter had failed. I was quick to think that it was most likely a mistake of the screener, because my daughter showed no signs of having poor vision. Despite other family members (myself included) wearing glasses, she never showed any sign of vision struggles. Her older brother started squinting in kindergarten and ended up with glasses - but my little girl - not the case.
Imagine my horror when after taking her to an Ophthalmologist I learned that she was indeed legally blind in one eye and had a condition previously unknown to me - called anisometropic amblyopia. If left untreated she would ultimately lose her functional vision in one eye. I'd never heard of Amblyopia before, but it is really quite common. It is estimated that 2-5% of the population has Amblyopia - that is more than 1 in 50 children and 1 in 20 preschool age children have this neurological condition.
What is Amblyopia?
You may know Amblyopia because of the more common layman's term of "Lazy Eye". The term lazy eye is most often associated with an image of a wandering or crossing eye - but this is not always the case. In anisometropic amblyopia there is no outwardly visible sign. There are actually two types of Amblyopia.
Anisometropic amblyopia - This is the type of Amblyopia that my daughter has. This is amblyopia resulting from a prescription difference between the right and left eye. In my daughter's case, her right eye was relatively good and her left eye was extremely farsighted. Her brain relied on her good eye and shut off/ignored her left eye allowing the vision in the left to decline.
Sometimes amblyopia occurs as a result of other strabismus (misaligned eyes) which could be an eye that turns or "floats" - this is called Strabismic Amblyopia.
Treating Amblyopia
If left untreated Amblyopia will result in blindness in the amblyopic eye. This is the path that we were headed with my daughter's vision as her left eye was already so bad that she could not even see the "big E" at the top of the eye chart when her right eye was covered up. Amblyopia is best treated young and children before the ages of 5-7 years of age have the best response rates to treatment. My daughter was diagnosed with Amblyopia at age 4 - which is still quite young but our window of opportunity with a case of the severity as hers is small and so we must be diligent and very pro-active in our treatment.
Prescribing glasses, alone, will not 'cure' or reverse amblyopia in most cases. Glasses are usually the first course of treatment for children with amblyopia but they will not correct the situation entirely.
Because amblyopia is neurological the weak or "lazy" eye has to be switched back on and put to use. This is done through occlusion of of the good eye to force the brain to use the other eye to see. This is hard work and tiring for the eye but it does work. Occlusion can be done through the use of an eye patch or by using blurring/dilating drops to the good eye -- or a combination of drops and patching. Depending on the case - vision therapy and surgery (to correct muscle imbalance) are also option.
Wearing an eye patch isn't real fun, can be socially traumatic, and is also very exhausting for the good eye and the child. There are a handful of childrens books out there, like The Patch and Apple Patty Patches- and even a DVD called "The Eye Patch Kids" aimed at helping kids and parents be successful with patching. My daughter wears fancy fabric patches that go on her eyeglasses and coordinate to her outfits though "pirate" style patches and adhesive band-aid style patches are also an option.
We are hopeful that her vision in the amblyopic eye will be restored and are working closely with her eye doctor whom she sees on a monthly basis. With patching you have to watch closely to ensure that you aren't patching the good eye too much or that eye can also become amblyopic.
In conclusion
You might be wondering how it is possible that I had no idea my daughter couldn't see out of one eye. Quite simply - she fooled us all. She was using just one eye and that eye sees pretty good. She wasn't struggling in school and she never complained that she couldn't see. The truth of the matter is - she didn't know any differently. How long was this going on? Really, we have no idea. She passed the vision screenings at her pediatric well visits (she must have cheated or peaked when they test the eyes separately..is all we can think). How or why we will not know but we do know that it got detected in preschool and we are taking care of it. Looking back I now can recognize several 'tip offs' that are signs of a possible vision issue but they are so subtle and also 'typical' for young children. This includes things like stumbling and tripping, poor depth perception (running into walls or corners), strong fears (of the dark, heights, rides), and tipping her head to the side when she watches TV or looks at you.
What I've learned the hard way is - vision screening by a trained eye professional is a must for all children including infants. Amblyopia can be detected in babies as young as 6 months of age using equipment called the Enfant Pediatric VEP Vision Testing system. The infantSEE program is also available and provides free and low cost eye exams for babies. Children do not need to know their letters or know how to read to complete an eye test. My daughter's doctor uses both letters, pictures, and matching games (as well as looking into her eye) to get an accurate reading of her vision.
If you have a young child, get their eyes checked and protect your child's eyesight.
Vision loss due to Amblyopia can be halted and reversed.
For more info: http://www.amblyopiakids.com
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