Amblyopia or lazy eye is weak vision or vision loss in one eye that cannot be fully corrected with lenses. This eye condition can affect up to 5% of the general population. Amblyopia usually develops in children before age eight. This is also the key time to treat it since results are better the earlier they are implemented. It becomes more difficult to treat amblyopia after the early teenage years. Untreated, amblyopia can, in rare cases, lead to blindness in the affected eye.
Amblyopia is a neurodevelopmental disorder that affects at least 2% of most populations and can lead to permanently reduced vision if not detected and treated within a specific period in childhood.
Amblyopia cause, why it happens
This eye disorder is caused when the brain favors one eye and refuses to use the other. Simply stated, it is a dysfunction of the brain which blocks vision from one eye because it can't use the two eyes together. Because the eye is "turned off, " clear vision does not develop in the lazy eye. Amblyopia affects 2 to 3 percent of the population.
Indian J Ophthalmology. 2014. Effectiveness of the addition of citicoline to patching in the treatment of amblyopia around visual maturity: a randomized controlled trial. o study the effectiveness of the addition of citicoline to patching in the treatment of amblyopia in the age group of 4-13 years. A randomized controlled trial, which included patients who were randomly divided into two groups. Both the groups received patching therapy till plateau was achieved in phase 1 of the study. Then in phase 2, group I received citicoline plus patching and group II continued to receive only patching. Outcome was measured by the visual acuity in logMAR every month in phase 1 till plateau was achieved and then for 12 months in phase 2. No significant difference was found in the mean visual acuities in these two groups in phase 1 till plateau was reached. In phase 2, for the initial four months, there was no significant difference in the visual acuities in these two groups, at the respective intervals. However, five months onward, up to 12 months, there was a significant difference in the visual acuities in these groups. The result was the same in younger patients (< seven years of age) as well as in older patients (> seven years of age). In phase 2, the mean proportional improvement in group I was significantly more than that in group II, at two months and onward, at the respective intervals. The improvement in visual acuity with citicoline plus patching was significantly more than that with patching alone, in one year of treatment.
Amblyopia treatment, how to improve
Although it is widely agreed that this condition that involves poor vision and/or poor muscle control of one eye, can be effectively treated in children younger than six, it has generally been believed that older children were unlikely to benefit from amblyopia treatment. The upper limit for successful amblyopia treatment response has been believed to be six to seven or nine to ten years of age. The current study is designed to evaluate the effectiveness of treatment of amblyopia in children aged seven to 17 years. Researchers conducted a randomized treatment trial of 507 older children with amblyopia at 49 clinical sites. All the patients were provided with optimal optical correction (children who already had glasses were given new ones). Children were then randomly assigned to receive treatment for amblyopia or to receive optical correction alone. Children aged seven to 12 in the treatment group were treated with two to six hours a day of patching over the sound eye combined with near visual activities such as playing with a GameBoy, homework, or reading, and one drop daily of atropine for the sound eye. Patients in the older treatment group (aged 13 to 17 years) were treated with patching and near visual activities alone. Follow up visits occurred every six weeks for up to 24 weeks until the patients were classified as a responder or non-responder. A patient in the study was classified as a responder if the amblyopic eye acuity (sharpness of vision) was 10 or more letters (two lines on the eye chart) better than baseline. A patient was classified as a non-responder if amblyopic eye acuity had not improved 10 or more letters by the 24th week or if there was no improvement at all from a prior follow-up visit (or baseline).
Of the 404 seven- to 12-year-olds in the study, 53 percent in the amblyopia treatment group were responders compared with 25 percent in the optical correction group. Of the 13- to 17- year-olds, 25 percent of the treatment group were responders compared with 23 percent of the optical correction group. However, of the13- to 17- year-olds who had not previously been treated for amblyopia, 47 percent responded to treatment compared to 20 percent who did not. Arch Ophthalmology. 2005.
Clin Neuropharmacol. 2016. Levodopa and Other Pharmacologic Interventions in Ischemic and Traumatic Optic Neuropathies and Amblyopia. The visual impairment in traumatic and ischemic optic neuropathy and amblyopia may be permanent. Hence, lots of efforts have been focused on neuroprotection. Dopamine is one of the suggested neuroprotective agents. Besides its important role in the brain, dopamine is found in various cell types of the retina, and is claimed to play a neuromodulator and neurotransmitter role there. The dopamine D1 receptor is the most highly expressed subtype of dopamine receptors, and its activation has been shown to be potentially neuroprotective against oxidative-stress damage in retinal neurons. Levodopa, a precursor of dopamine, can easily breach the blood-brain and blood-retinal barriers, and exerts effective dopaminergic responses in the brain and retina. This article summarizes and discusses the use of levodopa and other pharmacologic agents in the treatment of 3 groups of visual pathway disorders that primarily involve neuronal systems: ischemic optic neuropathy, traumatic optic neuropathy, and amblyopia.
Br J Ophthalmology. 2010. Effect and sustainability of part-time occlusion therapy for patients with anisometropic amblyopia aged > or =8 years. Department of Ophthalmology, Hallym University Sacred Heart Hospital, Republic of Korea.
To study the effect and long-term sustainability of part-time occlusion therapy for anisometropic amblyopia after 8 years of age. A total of 41 anisometropic amblyopes aged > or =8 years were analysed. In six patients, best-corrected visual acuity (BCVA) of amblyopic eye improved more than two lines within 2 weeks of full-time spectacle wear. The remaining patients were assigned to perform part-time patching during out-of-school hours. Long-term results were assessed in patients who were observed over 1 year after the end of the treatment. The part-time patching schedule was completed in 30 patients. 90% of patients complied well. Mean BCVA in the amblyopic eye improved significantly. The part-time occlusion treatment in school-aged amblyopes, which had been carried out after school hours, was successful and the effect was sustained in most cases.
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Laser acupuncture treatment
J Acupunct Meridian Stud. 2016. Amblyopia: Can Laser Acupuncture be an Option? Vanzini M, Gallamini M. After obtaining satisfactory results in the treatment of a 14-year-old amblyopic girl, the treatment was applied to 13 amblyopic children aged 3-11 years, with an encouraging outcome. An ultralow-light-intensity laser with a square-wave modulated emission was applied over a sequence of acupuncture points. Each session lasted less than 15 minutes, and the treatment was performed once a week in 6-week cycles. Patients were followed for several years to evaluate the long-term results and/or to extend the treatment. All except two of the treated patients showed a rapid increase in visual acuity after several treatment sessions. Some required retreatment for regressions in visual acuity. The need for medium-term treatment cycles seems, however, to suggest that results may not be stable for all individuals. Although acupuncture has already been proved to be effective in the treatment of amblyopia, results suggest that laser acupuncture at ultra-low-light-intensity levels can provide similar, if not better, results to conventional acupuncture stimulation, but with higher patient compliance.
The prevalence of strabismus and amblyopia in Japanese elementary school children.
Ophthalmic Epidemiol. 2005.
The purpose of this study is to elucidate the prevalence of strabismus and amblyopia in a large population of Japanese elementary school children, from Grade 1 to Grade 6, ages ranging from 6 to 12 years. The School Health Law requires that all pupils in Grade 1 to Grade 6 be examined for vision and eye problems. Visual acuity testing is done by school teachers and eye disease screening by school ophthalmologists. Pupils with suspected ocular diseases are further examined by extramural ophthalmologists and the results reported back to the schools. The schools then summarize and send uncorrected visual acuity and ocular disease incidence, together with other health statistics, to the municipal education committees. The data are forwarded to the Prefecture Governments and finally submitted to the Education Ministry of the Central Government. Both the Prefecture Governments and the Education Ministry publicize the school health statistics on their websites. The prevalence of strabismus and amblyopia remains unknown from these data because both diagnoses are included under the heading, eye diseases. Questionnaires asking about the numbers of children with different types of strabismus and amblyopia were sent to all elementary schools in Okayama Prefecture and the results were summarized. The number of children covered by the return of questionnaires was 86,531 (76%) of 113,254 total pupils in Grade 1 to Grade 6 in Okayama Prefecture in the year 2003. The total numbers of children with strabismus and amblyopia were 1,112 (1.28%) and 125, respectively. The numbers of children with any type of exotropia and any type of esotropia were 602 (0.69%) and 245, respectively. The major types of strabismus and amblyopia were intermittent exotropia in 109 children, accommodative esotropia in 19 children, anisometropic amblyopia in 23 children (0.03%), and ametropic amblyopia in 12 children (0.01%). The number of children with strabismus of unknown type was 245 while the number of children with amblyopia of unknown type was 81. The prevalence rates of strabismus and amblyopia in this population of Japanese elementary school children were lower than those reported in Western countries. The exotropia / esotropia ratio were increased in comparison with past studies in Japan. The school eye doctors need to be more diligent in identifying and diagnosing various types of strabismus and amblyopia in order to contribute to the school vision screening program already in place in Japan.
Amblyopia characterization, treatment, and prophylaxis.
Surv Ophthalmol. 2005. Simons K. Pediatric Vision Laboratory, Krieger Children's Eye Center, Wilmer Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
Amblyopia has a 1.6-3.6% prevalence, higher in the medically underserved. It is more complex than simply visual acuity loss and the better eye has sub-clinical deficits. Functional limitations appear more extensive and loss of vision in the better eye of amblyopes more prevalent than previously thought. Refractive correction alone may successfully treat anisometropic amblyopia and it, minimal occlusion, and/or catecholamine treatment can provide initial vision improvement that may improve compliance with subsequent long-duration treatment. Atropine penalization appears as effective as occlusion for moderate amblyopia, with limited-day penalization as effective as full-time. Cytidin-5'-diphosphocholine may hold promise as a medical treatment. Interpretation of much of the amblyopia literature is made difficult by: inaccurate visual acuity measurement at initial visit, lack of adequate refractive correction prior to and during treatment, and lack of long-term follow-up results. Successful treatment can be achieved in at most 63-83% of patients. Treatment outcome is a function of initial visual acuity and type of amblyopia, and a reciprocal product of treatment efficacy, duration, and compliance. Age at treatment onset is not predictive of outcome in many studies but detection under versus over 2-3 years of age may be. Multiple screenings prior to that age, and prompt treatment, reduce prevalence. Would a single early cycloplegic photoscreening be as, or more, successful at detection or prediction than the multiple screenings, and more cost-effective? Penalization and occlusion have minimal incidence of reverse amblyopia and/or side-effects, no significant influence on emmetropization, and no consistent effect on sign or size of post-treatment changes in strabismic deviation. There may be a physiologic basis for better age-indifferent outcome than tapped by current treatment methodologies. Infant refractive correction substantially reduces accommodative esotropia and amblyopia incidence without interference with emmetropization. Compensatory prism, alone or post-operatively, and/or minus lens treatment, and/or wide-field fusional amplitude training, may reduce risk of early onset esotropia. Multivariate screening using continuous-scale measurements may be more effective than traditional single-test dichotomous pass/fail measures. Pigmentation may be one parameter because Caucasians are at higher risk for esotropia than non-whites.
Arch Ophthalmol. 2010. Randomized controlled trial of patching vs acupuncture for anisometropic amblyopia in children aged 7 to 12 years. Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, China.
To compare the effectiveness of 2-hour daily patching with the effectiveness of acupuncture in treating anisometropic amblyopia in children aged 7 to 12 years who have worn optimal spectacles for at least 16 weeks. Acupuncture produced equivalent treatment effect for anisometropic amblyopia, compared with patching, and was statistically superior.
My son is 10 and he was diagnosed with amblyopia last year. The doctor told us he has it in both eyes. He changed his prescription, (this was a new doctor), and we went in for checkups. We started out at 20/50, with glasses, for close up and far away. About 4 months ago his close up had improved to 20/30, with glasses. The doctor kept his prescription the same without doing a diagnostic check and we are to go to him for a another examination where he will then check his eyes. We cannot patch his eyes to improve the condition because it is in both eyes. I asked him about natural supplements and he said there weren't any.