Wednesday, October 2, 2013

What is Lazy Eye?

At Koby Karp Doctors Eye Institute we conduct a large number of pediatric eye exams. Not infrequently, while performing kindergarten or school eye examination, we encounter a child with decreased vision due to “lazy eye”.   “Lazy eye”, or amblyopia, is a condition that occurs when a child does not fully develop vision in one or, sometimes, in both eyes.  Lazy Eye is affecting 1-3% of population and is the most common cause of visual loss during childhood (1).   
Dr. Albert Smolyar


Amblyopia develops whenever visual input to the brain from one or both eyes is imperfect due to blurry image from the eye(s). As a result, highly specialized visual areas in the developing brain of a child do not reach a full functional capacity. Since many of “lazy eye” cases are treatable if detected early, it is important to diagnose the affected children and start the appropriate therapy as soon as possible.
Cases of “lazy eye” ( Amblyopia):
There are several common causes of “lazy eye”.
1.      Due to opacity in the eye. This can be caused by cataract or a scar of the cornea, leading to loss of sharpness of visual image.
2.      Due to strabismus, or “crossed eyes”.
3.      Due to a significant optical imperfection of the eye, such as high degree of farsightedness
                     (hyperopia), nearsightedness (myopia) or astigmatism.
4.      Due to congenital droopy eyelid covering part of the eye(s) and obstructing visual axis.
Signs of “lazy eye” ( Amblyopia):
1.      Eye that turns in or out.
2.      Apparent lack of coordinated movement between the two eyes.
3.      Apparent lack of depth perception in a child.
4.      Apparent poor vision in one or both eyes.
5.      No obvious signs.
While some of cases of “lazy eye” may manifest with one of the above visual signs – may cases go undetected.  Unfortunately, when amblyopia is discovered late, particularly after age of 9 or 10 years of age – it is very difficult to reverse, since brain formation by that time is almost complete. However, it is possible to treat “lazy eye” in some cases up to teenage years, although the best results are achieved if the treatment instituted in the first years ( or even months) of child’s life.

Treatment of Lazy Eye:

A treatment of amblyopia depends on a cause of “lazy eye”.  If farsightedness, nearsightedness or astigmatism is the culprit – wearing corrective glasses could be the only treatment required. In some cases, patching of the visually better eye for several hours daily will facilitate improvement of the “weaker “eye (2). If a significant cataract or droopy eyelid is present surgery often may be required.  In some cases of strabismus (“crossed eyes”) surgery also may be necessary, although certain  cases resolve with simple glasses wear.

Summary:
If recognized early, “lazy eye” can frequently be reversed. At the same time, if overlooked, amblyopia leads to permanent visual deficit in 1-3 % of population.  Even in the absence of warning signs, eye screening by age of one year (and certainly before children enter kindergarten) represents an essential tool for detection and treatment of amblyopia (3) .

As one of the eye care leaders in the Kentuckiana area, Doctors Eye Institute is dedicated to prevention of amblyopia by early detection and, when needed, treatment.

Our Koby Karp Kids Club will be happy to provide your child with a free T-shirt and sunglasses along with all optical services to fulfill your child’s optical needs.

Schedule a pediatric eye exam at Koby Karp Doctors Eye Institute  (including school and kindergarten eye exams) with one of our doctors by calling (502) 897-1604.

- Albert E. Smolyar, MD

References:

1.      Identification and treatment of amblyopia. 
Bradfield YS.Am Fam Physician. 2013 Mar 1;87(5):348-52

2.      A Randomized Trial of Increasing Patching for Amblyopia.
Pediatric Eye Disease Investigator Group; Writing Committee, Wallace DK, Lazar EL, Holmes JM, Repka MX, Cotter SA, Chen AM, Kraker RT, Beck RW, Clarke MP, Lorenzana IJ, Petersen DB, Roberts JT, Suh DW.

Ophthalmology. 2013 Jun 4. pii: S0161-6420(13)00339-4. doi: 10.1016/j.ophtha.2013.04.008. [Epub ahead of print]

3.      Effectiveness of screening for amblyopia and other eye disorders in a prospective birth cohort study. de Koning HJ, Groenewoud JH, Lantau VK, Tjiam AM, Hoogeveen WC, de Faber JT, Juttmann RE, Simonsz HJ.
 J Med Screen. 2013 Jul 19.
 




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