Your child’s vision begins to develop at birth for the next 6 years (known as the critical period) to reach the full matured potential by around 8-9 years old.  If your child fails his/her vision milestones tests due to poor visual development, your child may have one of these 2 eye conditions. It is IMPORTANT FOR THE CHILD TO HAVE A COMPLETE EYE ASSESSMENT by a Eye Specialists / Orthoptists / Optometrist to screen or diagnosis any potential eye conditions.

A. Amblyopia  (aka ‘lazy eye’)

Amblyopia occurs because the eye is NOT able to reach the full potential of its visual development as the eye is not used (in other words, neglected or lazy) by the child who prefers to use the other normal eye to see.  This is because the image seen with the affected eye is NOT as clear as the normal eye and the child prefers to see with the normal eye. Any disease which blurs or blocks the vision during childhood will result in amblyopia.

Causes of Amblyopia (lazy eye)

• Squints (the eye which is squinting will be neglected and become amblyopic)
• Refractive errors which have not been corrected with spectacles because it was NOT detected early
• Congenital cataract (cataracts which have formed at birth although this is rare)
• Cornea scarring due to infection or injury (also rare)

Risk factors which increase chance of amblyopia include;

• Premature Birth
• Low birth weight (especially less than 1.5kg)
• Born to mothers who had infection during the first trimester of pregnancy
• Family history of lazy eye
• Development abnormalities or genetic disorders (like Down’s syndrome)

Symptoms of Amblyopia (lazy eye)

A child with amblyopia may have NO VISUAL SYMPTOMS because the child may be using the other good eye which has normal vision.  For this reason, it is absolutely vital for all children (who are at risk) should be assessed using appropriate testing techniques and examined by an eye doctor, optometrist or orthoptist to screen for amblyopia.

Treatment of Amblyopia (lazy eye)

Amblyopia can be reversed if the situation is detected early during the visual development period (usually until the age of 8-9 years).  The earlier amblyopia is detected, the greater is the child’s chance of recovery.   Once a child is diagnosed to have amblyopia, the plan of action is one or a combination of the following treatment;

• Treatment of the underlying cause (if any) such as surgery for congenital cataract or corneal scarring before starting amblyopia therapy
• Amblyopia therapy using Eye Patching or Atropine Eye Drops to the good (i.e: normal) eye so that the amblyopic eye will be used by the child and prevent it from being neglected
• Squint surgery for the squinting eye (if deemed necessary)
• Glasses or contact lenses to treat any Refractive Errors.

The duration for patching the normal eye varies between 1 to 6 hours per day depending on the regime used and the severity of the amblyopia. It is important to use the lazy eye during the patching period by doing hand-eye exercises such as drawing, copying and colouring.

Compliance with therapy is the single most important factor determining a successful outcome.  It requires full cooperation of the child AND parents as well as strict supervision of the eye doctor or orthoptist to ensure good results.  Parents are encouraged to try get the child to USE THE LAZY EYE to do VISUAL ACTIVITIES like coloring, drawing, writing, doing dot-to-dot games or tablet games while the good eye is being patched. If the child is doing sleeping or doing nothing while the eye is patched, there will be minimal / no benefit at all !

Visual improvement usually starts after 1 month of effective therapy and patching will need to be carried on for between 6 months to a few years depending on the severity of the lazy eye.  Patching can be stopped when the vision has improved to almost normal (note that the lazy eye may not reach 100% normal so at best 90% vision can be considered successful result) or when there is no further visual improvement especially when the child has already reached 9 years of age.

Remember to patch the GOOD eye!

B. Squints (aka ‘cock-eyed’)

A squint is present when the 2 eyes are not aligned parallel to each other. When looking ahead, the squinting eye (or cock eye) is either deviated inwards or outwards and is known as a convergent or divergent squint respectively. When a child has a squint, the vision in the squinting eye will be suppressed and the child will prefer to use the normal eye all the time. This will lead to amblyopia (lazy eye) in the squinting eye. Squints usually appear between the ages of 1-3 years.

Treatment of Squints

Treatment of squints involves either patching the normal eye to reverse the amblyopia and/or squint surgery to align the eyes so that they become parallel again. Some squints (such as squints associated with hyperopia or convergence insufficiency) may not need surgery and instead, eye fusion exercises with spectacles may be sufficient to treat the squint.

Successful squint treatment should achieve the following objectives;

• allow the child to look normal (so that he/she will not be teased at school)
• treat the amblyopia (lazy) eye
• restore some degree of binocular vision

It is essential for your child to get regular follow-up consultation with your eye doctor, orthoptist or optometrist to monitor your child’s visual progress during the critical period until the age of 8-9 years old

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Disclaimer. TELEME blog posts contains general information about health conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice and should not be treated as such. 

If you think you may be suffering from any medical condition, you should seek immediate medical attention from your doctor or other professional healthcare providers. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.