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It is not easy to recognize amblyopia. Unlike adults, a child is usually unaware if one of his/her eyes has reduced vision. Unless the child has a misaligned eye or other obvious external abnormality, there is often no way for parents to tell that something is wrong. Some of the symptoms could include:

• Decreased vision in one or both eyes
• Strabismus (misaligned eyes)
• Poor depth perception              

The symptoms described above may not necessarily mean that your child has amblyopia. However, if you observe one or more of these symptoms, contact your child's ophthalmologist for a complete exam.

Risk factors

• Positive family history of strabismus (misaligned eyes), amblyopia, childhood cataract or glaucoma
• Some genetic disorders that affect the eyes
• Strabismus
• Pediatric cataracts or glaucoma
• Droopy eyelid (ptosis)
• Eyelid tumor that blocks the pupil

It is difficult to measure vision in very young children at an age in which treatment is most effective. Your ophthalmologist knows how to estimate visual acuity in an infant by watching how well a baby follows an object with one eye when the other eye is covered. He or she also will carefully examine the refractive error and optical clarity of the interior of the eye to see if other eye disorders such as cataract, glaucoma, tumor, or inflammation inside the eye may be causing decreased vision and lead to amblyopia.

Some of the tests include:

• Visual acuity measurement in each eye and both eyes together (age appropriate)
• Cycloplegic refraction (with dilating eye drops)
• External or slit lamp exam
• Fundus (retina) examination
• Complete eye exam (age appropriate)

To correct amblyopia, a child must be forced to use the weaker eye. This usually is accomplished by correcting any abnormalities of the amblyopic eye (refractive error, visual opacities, retinal problems, etc.) to improve the vision potential in the ignored or amblyopic eye, and by patching (covering) or otherwise temporarily reducing the vision of the stronger eye (penalization). Some part-time patching will often be required for weeks, months, or even years in order to restore the best possible vision and maintain the improvement in the amblyopic eye. Glasses may be prescribed to correct refractive errors in one or both eyes. Occasionally, amblyopia is treated by blurring the vision in the good eye with special eye drops (atropine) or lenses to force the child to use the amblyopic eye.

Amblyopia sometimes is treated with glasses, patching or eye drops before or at the same time as surgery to correct misaligned eyes, remove a cataract, or correct another ocular abnormality. In some cases, cataract, glaucoma, or lid surgery may be necessary to treat deprivation amblyopia. Patching may be required even after surgery to improve vision; glasses or contact lenses may be required to restore appropriate focusing.

It is very important that you and your child fully comply with the treatment prescribed by your ophthalmologist. Children typically do not like to have their good eye patched, wear corrective lenses, or receive eye drops. And, since they have become dependent on their “good” eye to see clearly, they often feel as though you are blinding them when you patch or blur the unaffected eye. But, as a parent, you must convince your child to do what is best for his/her future vision because successful treatment depends on it.  And, with initial consistent therapy, the vision in the amblyopic eye will improve and the treatment will become easier.

If amblyopia is not treated early, specifically during the period of visual development between birth and 6 to 9 years of age, it can result in a permanent visual defect or loss of depth perception. Then, later in life, if the “good” eye becomes diseased or injured, a lifetime of poor vision with a resulting handicap (the inability to drive or work) may occur.

If the problem is detected and treated early, vision will improve for most children. Sometimes part-time treatment may have to continue until the child is 6 to 9 years of age and vision development is complete. After this time, amblyopia usually does not return.

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