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Pediatric

Vision Development

Development of vision occurs between birth and 7 years of age.

If a child cannot use his or her eyes normally, vision does not develop properly and may even decrease. This is called amblyopia. After the first nine years of life, the visual system is virtually fully developed and usually cannot be changed.

The development of equal vision in both eyes is necessary for normal vision. Many occupations are not open to people who have good vision in one eye only.

If the vision in one eye should be lost later in life from an accident or illness, it is essential that the other eye have normal vision. Without normal vision in at least one eye, a person is visually impaired.

For all of these reasons, amblyopia must be detected and treated as early as possible.

What is amblyopia?

Amblyopia is poor vision in an eye that did not develop normal sight during early childhood. It is sometimes called "lazy eye."

When one eye develops good vision while the other does not, the eye with poorer vision is called amblyopic. Usually, one eye is affected by amblyopia.

The condition is common, affecting approximately two or three out of every 100 people. The best time to correct amblyopia is during infancy or early childhood. Parents must be aware of this potential problem if they want to protect their child's vision.

When should vision be tested?

It is recommended that all children have their vision checked by their family Eye M.D. at or before their fourth birthday.

New techniques make it possible to test vision in infants and young children. If there is a family history of misaligned eyes, childhood cataracts or a serious eye disease, an Eye M.D. (ophthalmologist) can check vision even earlier than age three.

What causes amblyopia?

Amblyopia is caused by any condition that affects normal use of the eyes and visual development. The three major causes are:

Strabismus (misaligned eyes)

Amblyopia occurs most commonly with misaligned or crossed eyes. The crossed eye 'turns off' to avoid double vision and the child uses only the better eye.

Unequal focus (refractive error)

Refractive errors are conditions that are corrected by wearing glasses. Amblyopia occurs when one eye is out of focus because it is more nearsighted, farsighted or astigmatic than the other. The unfocused (blurred eye) 'turns off' and becomes amblyopic. The eyes can look normal but one eye has poor vision. This is the most difficult type to detect and requires careful measurement of vision.

Cloudiness in the normal clear eye tissue or lid droop

An eye disease such as a cataract (clouding of the eye's natural lens) or ptosis (lid drooping) may lead to amblyopia. Any factor that prevents a clear image from being focused inside the eye can lead to the development of amblyopia in a child. This is often the most severe form of amblyopia.

How is amblyopia treated?

To correct amblyopia, a child must be made to use the weak eye. Patching or covering the good eye, often for weeks or months usually does this. Even after vision has been restored in the weak eye, part-time patching may be required over a period of years to maintain the improvement.

Glasses may be prescribed to correct errors in focusing. If glasses alone do not improve vision, then patching is necessary. Occasionally, amblyopia is treated by blurring the vision in the good eye with special eye drops or lenses to force the child to use the amblyopic eye.

Amblyopia is usually treated before surgery to correct misaligned eyes, and patching is often continued after surgery as well.

If your Eye M.D. finds a cataract or other abnormality, surgery is required to correct the problem. After surgery, glasses or contact lenses can be used to restore focusing, while patching improves vision.

The weaker eye must be made stronger in order to see normally. Prescribing glasses or performing surgery can correct the cause of amblyopia, but your Eye M.D. must also treat the amblyopia itself.

If amblyopia is not treated, several problems may occur:

Your Eye M.D. can give you instructions on how to treat amblyopia, but it is up to you and your child to carry out this treatment.

Successful treatment mostly depends on your interest and involvement, as well as your ability to gain your child's cooperation. In most cases, parents play an important role in determining whether their child's amblyopia is to be corrected.

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