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Detection and Diagnosis of Lazy Eye
An eye exam by a pediatrician or the 20/20 eye chart screening is not adequate for the detection of amblyopia (and other visual conditions). The most important diagnostic tools are the special visual acuity tests other than the 20/20 letter charts currently used by schools or peditricians.
Since amblyopia usually occurs in one eye only, many parents and children are unaware of the condition. Many children go undiagnosed until they have their eyes examined at the eye doctor's office at a later age.
Treatment of Amblyopia (Lazy Eye)
Treatment may involve glasses, patching, drops, and/or vision therapy. Recent medical research has proven that amblyopia is successfully treated up to the age of 17. See National Institutes of Health -- National Eye Institute; Older Children Can Benefit From Treatment; Lazy Eye. Although improvements are possible at any age with proper treatment, early detection and treatment still offer the best outcome.
Early Detection and Treatment of Strabismus
According to both the American Optometric Association and American Ophthalmological Association, all children should have their first examination around 9 months of age. However, if an extreme or constant eye turn is noticed, the baby should be examined before 9 months. If a constant eye turn or significant refractive error is found, the eyes need to be fully evaluated and corrected as early as possible. This is one of the biggest reasons that we offer Infantsee exams at our clinic.
Why So Young?
The development of keen binocular vision with resultant stereopsis is a result of genetics and appropriate development of the binocular system during the early formative years. The ability to see 20/20, focusing ability (accommodation), eye muscle coordination (aiming or alignment) and stereopsis are all developed by 6 months of age in humans. By 9 months of age, the system is in place.
In general, research suggests that the maximum "critical period" in humans is from just after birth to 2 years of age. Any disruption of binocular vision from 6 months to approximately 4 years will result in strabismus and/or amblyopia. Problems with binocular vision are often not detected by the untrained observer. Thus, every infant without an apparent problem should have their first examination between 9 months to one year of age. By all means, do not hesitate to have children with extreme or constant eye turns examined before 6 months.
Young babies are also easy to exam. Age 2 is neurologically late and a difficult time to examine the young toddler.
How Would the Eye Doctor Examine an Eye Turn?
The most important diagnostic tool is the history as this allows the doctor to know the age of onset, duration of turning, family history of strabismus, and a medical history. The eye doctor will then attempt to rule out amblyopia, uncorrected refractive error, and amount of deviation. The doctor should dilate the eyes to make sure that there is no hidden eye disease causing the strabismus.
Children with strabismus and amblyopia (lazy eye) must be identified and treated at a young age to obtain the best chances of restoring normal visual acuity in the presence of amblyopia and/or constant strabismus. Thus, the first examination should be performed just after the visual system has completed maturation, so treatment can be initiated immediately, if necessary. This is the period of time in which the visual system is most easily modified.
Will my child outgrow strabismus?
Children do not grow out of eye turns. Proper diagnosis and treatment is necessary. Treatment will depend on the condition and individual. Although, intermittent eye turns do not require aggressive treatment, professional evaluation and monitoring is still recommended.
Eyeglasses may be prescribed to eliminate the eye turn and/or eliminate any optical difference between the eyes. The eye doctor might institute patching to stimulate the "lazy" eye, which was suppressed or turned off (when the two eyes are not aligned, the brain is forced to ignore one of the images to prevent double vision).
Infants or young children should be encouraged to do things which involve hand and eye coordination. Movement and hand eye tasks speed the improvement in treatment of amblyopia and strabismus.
For additional information, or questions about strabismus, including questions about surgery, please feel free to contact our office at (763) 241-1090 or visit: