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Amblyopia

Amblyopia, or lazy eye, is a disorder of the eye. It is characterised by poor or blurry vision in an eye that is otherwise physically healthy and normal. The problem is caused by either no transmission or poor transmission of the visual image to the brain for a sustained period of dysfunction or disuse during early childhood. The condition will only arise at this young age because most of the visual system's development in humans is complete and "locked in" by a few years of age. more...

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Amblyopia normally only affects one eye, but it is possible to be amblyopic in both eyes if both are similarly deprived of a good, clear visual image.

Amblyopia affects 2-5% of the population. Amblyopia is a developmental problem in the brain, not an organic problem in the eye. The part of the brain corresponding to the visual system from the affected eye is not stimulated properly and develops abnormally. This has been confirmed in brain specimens.

Many children who have amblyopia, especially those who are only mildly amblyopic, are not even aware they have the condition until tested at older ages, since the vision in their stronger eye is normal. However, people who have severe amblyopia may experience associated vision disorder, most notably poor depth perception.

Types

Amblyopia can be caused by deprivation of vision early in life, or by strabismus (misaligned eyes), vision obstructing disorders and anisometropia (different degrees of myopia or hyperopia in each eye).

Strabismic amblyopia

Strabismus, sometimes known as lazy eye, will result in normal vision in the fixating eye, but abnormal vision in the strabismic eye due to the brain discarding certain information. Strabismus usually develops into double vision (diplopia) in adulthood, since the two eyes are not fixated on the same object. Children's brains, however, are more plastic, and therefore can more easily adapt by ignoring images from one of the eyes, getting rid of the double vision. This plastic response of the brain, however, interrupts the brain's normal development, resulting in the amblyopia.

Strabismic amblyopia is best treated by treating the strabismus through the use of prescription glasses, vision therapy, surgery or patching.

Refractive amblyopia

If anisometropia is present, refractive amblyopia may result. Anisometropia exists when there is a difference in the refraction between the two eyes. The eye with less refractive error provides the brain with a clearer image, and is favoured by the brain. Those with this condition are more susceptible to the development of amblyopia, which may be as severe as strabismic amblyopia. Despite its severity, refractive amblyopia is commonly missed by primary care physicians because of its less dramatic appearance and lack of obvious physical manifestation, such as with strabismus .

Refractive amblyopia is diagnosed when there is a wide disparity in visual acuity between the two eyes. Refractive amblyopia is treated by correcting the refractive error early with prescription lenses. Vision therapy and/or eye patching can also be used to develop and/or improve visual abilities, binocular vision, depth perception, etc.

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Amblyopia treatment may benefit older children
From Optometric Management, 5/1/05

AGE IS NO LONGER THE DECIDING FACTOR, SAYS INVESTIGATOR

Older children who suffer from amblyopia stand a better chance of benefiting from treatment than previously thought, according to a study published in the April issue of Archives of Ophthalmology. The nationwide clinical trial showed that many children aged 7 to 17 with amblyopia may benefit from treatments more commonly used on younger children. The findings challenge the belief, previously held by many in eye care, that this population was untreatable.

Researchers divided 507 children into two groups. One group was fitted with new prescription glasses only. The other group was fitted with glasses as well as an eye patch, or the eye patch along with special eye drops, to limit the use of the unaffected eye. These children were also asked to perform near-vision activities. The patching, eye drops and near activities force the child to use the amblyopic eye. Patching was prescribed for periods of two to six hours daily; the eye drops were administered daily for the children seven through years old.

The investigators defined successful vision improvement as the ability to read (with the amblyopic eye) at least two or more lines on a standard eye chart. They found that 53% of children age 7 to 12 years who received glasses and patch treatment and near activity met this standard, versus only 25% of those children in the same age group who received only glasses. For children age 13 through 17 years who were treated with both glasses and patches (this group did not receive drops), 25% met the standard, versus 23% of children of these ages who received only glasses. Further, the study showed that among children age 13 through 17 years who had not been previously treated for amblyopia, 47% who were treated with glasses, patching and near activity improved two or more lines compared with only 20% of those treated with spectacle correction alone. However, most children, including those who responded to treatment, were left with some visual impairment.

"This study shows that age alone should not be used as a factor to decide whether or not to treat a child for amblyopia," says Mitchell M. Scheiman, O.D., study co-chair. "The opportunity to treat amblyopia does not end with the pre-school years." The National Eye Institute, which funded this study, is supporting a one-year follow-up study to determine the percentage of amblyopia that recurs among the children who responded well to treatment.

Copyright Boucher Communications, Inc. May 2005
Provided by ProQuest Information and Learning Company. All rights Reserved

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