What happens with amblyopia
A child’s vision develops in the first years of life: the brain learns to process the image from two eyes and combine it into one three-dimensional picture. If one eye sees blurred or looks to the side, the brain receives two different images and, to avoid double vision, suppresses the signal from the worse eye. Over time, the nerve connections of this eye develop weaker, and even with glasses it sees worse. Such suppression is reversible as long as the visual system remains plastic, most successfully in preschool and primary school age.
- Strabismus - with strabismus
- Refractive anisometropic - with different eye powers
- Refractive – with high farsightedness or astigmatism in both eyes
- Deprivation - for cataracts, ptosis, corneal opacities
- One-sided and two-sided
Causes and risk factors
The most common cause is strabismus, in which the eyes look at different points. The second place is occupied by anisometropia, when one eye is nearsighted, farsighted or with astigmatism stronger than the other; Outwardly it is not noticeable at all. High refractive errors in both eyes can lead to bilateral amblyopia. The deprivation form is dangerous: congenital cataracts, severe ptosis or clouding of the cornea completely deprive the eyes of a clear image, and treatment must begin very early. The risk is higher in premature babies and in cases of amblyopia and strabismus in the family.
- Strabismus
- Different refraction of two eyes
- High farsightedness and astigmatism
- Congenital cataract
- Upper eyelid ptosis
- Prematurity and developmental delay
- Amblyopia or strabismus in relatives
How to suspect a child
Young children rarely complain about poor vision in one eye, because they are used to seeing in the other. Parents should be alert to squinting, squinting or closing one eye in bright light, or tilting or turning the head when looking at objects. The child may bump into objects on one side, have trouble catching the ball, and get tired quickly when drawing and reading. If you cover your healthy eye with your palm, the child sometimes becomes capricious or tries to remove his hand. However, often there are no external signs, and amblyopia is detected only during examination.
- Strabismus
- Squinting or closing one eye
- Head tilt
- Anxiety when closing one eye
- Awkwardness, poor distance judgment
- Difficulty reading and drawing
Diagnostics
The ophthalmologist checks the vision of each eye separately using age-appropriate tables - pictures or symbols. An obligatory step is to determine the refraction after instilling drops that relax accommodation, since without this, farsightedness in children is underestimated. The doctor evaluates the position and movements of the eyes, performs a cover test, and examines binocular vision. Examination of the fundus and optical media is necessary to exclude cataracts, diseases of the retina and optic nerve. The diagnosis of amblyopia is made when best-corrected vision is reduced and there is no organic cause.
- Checking visual acuity in each eye
- Autorefractometry with cycloplegia
- Cover test for strabismus
- Binocular vision study
- Biomicroscopy and fundus examination
- Preventive examinations at 1 month, 1 year, 3 years and before school
Treatment
The first step is complete spectacle correction: in some children, the vision of the weak eye improves after just a few months of constant wearing of glasses. If this is not enough, occlusion is used - gluing the better-seeing eye with a special sticker for a certain number of hours a day to force the weak eye to work. An alternative is atropine drops in the strong eye, which temporarily blurs its vision. Binocular computer programs are also used. Causes of deprivation, such as cataracts or ptosis, are eliminated surgically. The treatment regimen is prescribed only by a doctor, and monitoring is needed regularly, as amblyopia may return.
- Constantly wearing glasses
- Occlusion is better than the seeing eye
- Atropine penalization
- Binocular training
- Surgical treatment of cataracts and ptosis
- Treatment of strabismus
- Regular monitoring after completion of treatment
