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Pediatric Ophthalmology

Amblyopia (lazy eye) Screening and Treatment

Amblyopia is also known colloquially as ‘lazy eye’. Amblyopia always afflicts the young, and if undetected or left untreated, amblyopia invariably leads to permanent impairment of vision. Amblyopia afflicts about seven percent of the population.

In the first decade of life, the developing brain makes new neural connections with the eyes. With a pair of health eyes, each producing equally sharp images to the child’s brain, and in response, the brain makes equal number of neural connections with each eye. As result, the brain uses each eye equally. With two equally well-functioning eyes, the brain enjoys sharp vision as well as excellent depth perception.

However in cases where one eye projects blurrier images to the brain compared to its fellow eye, the developing brain will selectively make more neural connections with the eye that sends sharper images. Any conditions that obstruct light transmission (i.e., cataract and corneal scar), impair focusing (i.e., nearsightedness, farsightedness, and astigmatism) or cause misalignment of the eyes (i.e., one eye turning in or out) can lead to amblyopia.

Diagnosis of amblyopia can be difficult at times, since infants and young children typically cannot or do not voice visual difficulty in the amblyopic eye, since they rely mainly on the fellow normal eye. Amblyopia is typically first suspected by child’s caretaker (usually the mother) based on the child’s behavior or by child’s failure to pass vision screening conducted at school or the doctor’s office.

Once loss of vision is detected in a child, she is referred to a pediatric ophthalmologist for evaluation. Ophthalmic examination of a baby or young child can be challenging. At such young age, the patient has short attention span and can be uncooperative. Careful examination coupled with gentleness and patience, the pediatric ophthalmologist can detect mildest form of amblyopia even in most recalcitrant children.

The dictum in treating amblyopia is - earlier the detection, earlier the treatment, better the outcome. The treatment of amblyopia has to be tailored to the patient’s eye condition. In cases of cataract and corneal scar, early surgery may be indicated. In cases of farsightedness, nearsightedness, and astigmatism, proper glasses are prescribed. After a clear ocular media is established and the optimal glass prescription filled, eye patching commences. Eye patching involves covering the healthy or non-amblyopic eye for a certain period of time every day depending on the severing or amblyopia. Eye patching forces the brain to use the amblyopic eye and to make more neural connections to the ‘lazy eye’.

Eye patching can be challenging to the child and the parents. The child is usually too young to understand the purpose of eye patching and during the initial phase of treatment will try to circumvent it by either removing the eye patch when parents are not present or by not wearing the eye patch properly. The parents frequently become frustrated with having to be constantly vigilant to make sure that the eye patch is worn properly. Fortunately, the beneficial effects of eye patching set in rather quickly especially in babies and young children, usually within few weeks. Once the vision of the amblyopic eye improves with eye patching, the subsequent patching becomes easier. Recently, studies have demonstrated that using dilating eye drops that fogs the vision in the non-amblyopic eye can be just as effective as eye patching. Some families might find dilating eye drop as a better alternative to eye patching.

Amblyopia treatment may take years, especially when lazy eye was discovered early. Patching is usually continued until age nine to ten, at which the brain’s visual system matures. Until then, frequently follow-up visits with the pediatric ophthalmologist are imperative to make sure the child is making progress and maintaining good vision in the previously amblyopic eye. However, once the brain’s visual system mature, amblyopia treatment is no longer effective. There is only a precious window of opportunity in a child’s life, in which we can reverse amblyopia.

DuPage Ophthalmology is a referral center for pediatric eye disorders in Chicago area. Our pediatric ophthalmologist is Dr. Gupta, who has extensive clinical experience and surgical expertise in the diagnosis and treatment of amblyopia. Dr. Gupta is an assistant professor of clinical ophthalmology at the University of Chicago Pritzker School of Medicine.

Strabismus Screening and Treatment

Strabismus is the condition, in which the eyes are not properly aligned. Strabismus can afflict all age groups and its onset can be sudden or gradual. In some cases, the misalignment of the eyes is present at all times, while in others, it occurs intermittently - such as with near visual tasks, looking only in certain directions, or during times of fatigue or inattention. Adults with strabismus frequently present with complaint of double vision, unless they have had strabismus since childhood. Children, who develop strabismus, usually do not complain of double vision, especially when the child is very young. Typically it is the mother or the caretaker who first notices the ocular misalignment.

There are six eye muscles in each eye socket that control the movement of the eye. Strabismus can occur due to weakness, over-action, scarring, inflammation, or entrapment of the muscles that control eye movements. For conditions such as thyroid disease, trauma, stroke, myasthenia gravis, strabismus could be the first sign of disease. In some cases, the development of strabismus could be due to loss of vision in one eye, which can be caused by cataract, retina detachment, or intraocular tumors (e.g., retinoblastoma).

The diagnosis of the underlying cause of strabismus in a child can be highly complex and requires the expertise of a pediatric ophthalmologist. A detailed complete eye examination is a must. Correct diagnosis is crucial because the treatment of strabismus may differ from cases to case depending on its underlying cause. On rare occasion, a timely diagnosis can save the strabismus patient’s life, such as in case of retinoblastoma.

If the misalignment is correctable with glasses then the proper spectacles are prescribed. If there is amblyopia (lazy eye) is the underlying cause, then it must be treated appropriately. If the eyes remain misaligned even after proper glasses are prescribed and full treatment of the underlying amblyopia, surgery of the eye muscles is frequently needed to re-establish the proper ocular alignment and binocular vision.

Pediatric strabismus (eye muscle) surgery is usually performed as outpatient and the recovery period is short. Strabismus surgery involves weakening and strengthening certain eye muscle groups in order to re-establish proper ocular alignment. Depending on the case, muscle surgery is performed on one eye or both eyes. Periodic follow-up examination is important to ensure that the eyes remain aligned and the vision in the amblyopic (lazy) eye does not regress.

Well-Child Eye Examination (School Eye Screening)

DuPage Ophthalmology has instituted the well-child eye examination, at a reasonable cost, for children scheduled to enter kindergarten or the upcoming school year. The goal of well child eye exam is to screen for visual impairments that can hamper child’s school performance. As mandated by Illinois State Statutes, every preschooler must undergo eye screening prior to entering kindergarten. Usually, the well-child eye examination takes less than 30 minutes with no discomfort to the child. However, if eye pathology is uncovered, a subsequent complete pediatric eye examination must be scheduled and performed.

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