Amblyopia | Diagnosis & Treatment

How is amblyopia diagnosed?

All children should have a vision test before their fourth birthday. Most pediatricians test vision as part of the standard medical exam and refer the family to an ophthalmologist if they detect signs of a problem.

While checking a child’s vision, the pediatrician or ophthalmologist may cover one eye at a time and see how well the child can follow an object with the other eye. They may also watch the child’s reaction to having an eye covered. If the child becomes upset or tries to pull the cover away, it could be a sign of amblyopia.

How is amblyopia treated?

The sooner amblyopia is caught and treated, the better the child’s chances for a positive outcome.

Treatment depends on what type of amblyopia a child has, and how severe it is.

Refractive amblyopia

Children with refractive amblyopia, lazy eye caused by astigmatism, nearsightedness or farsightedness, are typically treated with patching. This non-invasive procedure involves blocking the stronger eye, thus forcing the brain to see out of the weaker eye. The ophthalmologist may suggest one or more of the following forms of patching:

  • a patch over the stronger eye
  • eye drops to temporarily blur the vision in the stronger
  • eye eyeglasses that blur the vision in the stronger eye

Patching can take weeks or months to take effect and may need to be continued part time for several years to ensure equally strong vision in both eyes.

Strabismus

Mild cases of strabismus can often be treated effectively with prescription glasses or patching. If a child has severe strabismus, the ophthalmologist may recommend surgery to realign the crossed eye with the brain.

Surgery involves detaching the muscle or muscles that are pulling the eye out of alignment and reattaching it or them to a new spot.

A few hospitals offer Botox injection, a minimally invasive procedure that temporarily weakens the muscle that is pulling the eye out of alignment.

Cataracts

If amblyopia is caused by cataracts, the treatment will depend on the age of the child and size of the cataract. As a general rule, the older the child, the less urgent it is to perform cataract surgery right away. If the cataract is a tiny dot on the lens, the doctor may recommend patching and possibly having the child wear glasses or contact lenses. Patching the unaffected eye forces the eye with the cataract to develop better vision.

Children born with dense cataracts need surgery as soon as possible. During surgery, the cloudy lens is removed and may be replaced with an intraocular implant, a clear, plastic permanent lens. However, due to the risk of complications, an intraocular implant may not be the best option for a very young child. In such cases, the child may instead be fitted with a specialty contact lens a few days after the surgery. This may be a temporary solution to help the child see until they are old enough for implant surgery or the eye may work fine with the contact lens and not require further surgery.