Before a treatment and management plan can be developed, you first need to diagnose the amblyopia and its underlying cause. A normal comprehensive eye exam is all that is required to diagnose amblyopia. There usually are not any other diagnostic tests needed when a child has vision loss except when some underlying disease pathology is felt to be a possibility. This occurs in very rare cases.
Treatment of the Underlying Conditions Related to the Amblyopia
If there is a strabismus (crossed or turned out eyes), then the proper treatment for the strabismus must be done in order to begin the treatment or management of the amblyopia. Surgery may be necessary to fix the strabismus. In many cases glasses may relieve the crossed eyes. Once this is accomplished, then the treatment of the amblyopia can begin.
Anisometropia or High Refractive Error
If it is found that the child needs glasses to help correct the vision, this should be done first before the treatment and management of the amblyopia can begin.
If the child has an eye disease that is blocking the vision such as congenital cataracts or corneal scarring, then it must be repaired before the treatment of the amblyopia can begin.
Treatment and Management of Amblyopia
The most important factor in treating amblyopia is the early detection and treatment of the amblyopia.
Patching of the good eye to improve the development of good vision in the other eye is the most common form of treatment for amblyopia. Patching of the good eye can be difficult to accomplish in many children as they are not happy with the quality of the vision in the poor eye. Parents have to be diligent in following the management of amblyopia.
Pharmacologic (Atropine eye drops) can be used in the good eye to paralyze the focusing of that eye. The vision is then blurred in the good and the brain tries to use the weaker eye which helps it develop better vision.
The density or severity of the amblyopia will make the treatment time longer and usually require longer periods of patching or eye drops.
Follow up times of the child will depend on the age and severity of the amblyopia. They are typically 1 – 3 months.
Precautions and Warnings
Overly aggressive patching can lead to loss or amblyopia in the normal eye. Eye patches can irritate the skin. A new strabismus may appear. Atropine has certain side effects: photophobia (light sensitivity), rapid heart rate, flushing, and mood changes.
Reverse amblyopia is not common and is usually mild. It will most like resolve with stopping the treatment.
The best way to insure good results is to diagnose the child at a young age. The parents comply with the treatment protocol. The treatment should be gradually tapered as not to cause a reoccurrence.