My friend Mr. Li’s child is 4 years old, named Siying. The parents knew there was a problem, but thought it was just a cosmetic issue, so they didn’t care. A few days ago, when the kindergarten conducted a physical examination, they found that Siying could only see the top few lines of the vision chart clearly, so the teacher informed the parents to take their child to the ophthalmology department for further examination. Siying’s mother was anxious and rushed to the hospital to see me, asking, “What can I do if my child is so young and nearsighted? You must help me think of a solution!”
I did a comprehensive eye screening and checked the child’s vision again, and determined that the child had congenital ptosis in one eye, and that the vision in both eyes was 0.1 and 0.6, respectively, and that Siying’s corrected vision was not normal, at 0.8 and 0.3, respectively, after a dilated eye exam. The mother of Siying was even more confused: is it not myopia that the child cannot see clearly on the vision chart? How did it become amblyopia again?
This is actually one of the most common problems encountered in pediatric ophthalmology clinics. In fact, during early childhood (3 to 5 years old), children are rarely “myopic” (a few have congenital myopia), but at this age, the more harmful and more frequent are farsightedness, astigmatism and the strabismus and amblyopia caused by it. In Siying’s case, it is not only the droopy eyelid that blocks vision, but also the combination of refractive error that causes amblyopia.
Causes of Amblyopia
What exactly is amblyopia? Amblyopia is a condition in which there is no obvious organic pathology in the eye, or there are organic changes combined with refractive abnormalities, but the decrease in visual acuity is not compatible with the pathology, or the corrected visual acuity is less than 0.9, and can occur in one or both eyes.
There are many causes of amblyopia, the main ones are as follows.
1, strabismic amblyopia: strabismic eye is oblique, the object image projected on the retina at the bottom of both eyes does not fall on the normal corresponding point, thus causing diplopia and visual confusion, causing the brain to actively inhibit the strabismic eye vision, forming amblyopia over time.
2, refractive amblyopia: high refractive error in both eyes, the retina can not get a clear image for a long time, there is not enough stimulation, also make the development of visual function is hindered, resulting in amblyopia.
3. Visual deprivation amblyopia: common in congenital cataract, severe congenital ptosis. After birth, due to disease, the crystal of congenital cataract is cloudy, and severe congenital ptosis can obscure the pupil, so that the retina of one or both eyes does not receive the necessary visual stimulation, resulting in the cessation of visual development and the production of amblyopia.
The difference between the refractive errors of the two eyes is more than 250 degrees, and the difference in the size of the retinal image is so great that the object images of both eyes cannot be fused into one, and the visual center of the brain can only suppress the object images of the eye with higher refractive errors, and amblyopia occurs over time.
How to do amblyopia
The most important thing is to make sure that you have a good idea of what you are doing. This is because at this age (about 10 years old or later), the developmental period of the neural pathways of the eye and cerebral cortex is basically over, and there is little hope of improving visual acuity. Therefore, we often say that amblyopia treatment is a race against time for vision. We often encounter parents of children who failed to have their eyes examined and treated when they were young, and whose vision could not be improved as adults even with glasses, and lost the opportunity to be treated.
At present, the main methods applied for amblyopia treatment include spectacle wear and masking treatment, as well as various kinds of visual function training, etc.
1, wearing glasses treatment: mainly used for refractive error amblyopia, including a variety of farsightedness, myopia, astigmatism caused by amblyopia, according to the child’s specific circumstances, after the professional doctor optometry with appropriate glasses. By wearing glasses, the image entering the eye falls clearly on the retina, which enables the retina to obtain sufficient visual stimulation, corrects vision, promotes the development of vision, and achieves the purpose of treating amblyopia. Wearing glasses treatment should be carried out persistently, except for sleeping, washing and bathing, parents should urge their children to insist on wearing glasses until amblyopia is cured.
2. Masking treatment: This is a traditional and effective method with a history of more than 100 years. It must be used especially for patients with very poor vision in one eye. By covering the healthy eye and forcing the use of the amblyopic eye, the more complete the covering of the healthy eye, the better the effect. The length of time the eye is covered can vary depending on the age of the child and the vision of the two eyes. For example, you can cover the healthy eye for 3 days and open it for 1 day. In some cases, it can be opened for 1 day for 6 days. It should be carried out carefully according to the doctor’s prescription, and the vision should be checked regularly to adjust the amblyopia treatment plan.
3.Visual enhancement training: It is a commonly used means to treat amblyopia in our hospitals at present. It includes red light scintillation therapy and light brush therapy as well as fine visual acuity training. The first two need to be carried out under the guidance of doctors with special instruments and equipment. Here we mainly introduce the visual training by gazing at fine objects. The key to vision development is application, and fine vision training is a good application for amblyopic eyes, and a special exercise that is beneficial to visual development and vision improvement. In the early stage, you can practice wearing beads and buttons, and after the vision rises, you can practice wearing stitches and tracing red. Girls can practice embroidery, and boys can practice tracing, painting, calligraphy, etc. However, it is important to note that the amblyopic eye must be used during the practice.
Amblyopia treatment is a long-term, slow process, and there are no shortcuts. The degree of the disease, the time to seek medical attention, and the requirements for vision recovery will all have an impact on the outcome of treatment. The overall trend of vision recovery during the treatment process is a wave-like increase. Therefore, parents need to be patient and cooperate with the doctor to persist in the treatment of their children.
If there are any special conditions during amblyopia treatment, you should go to the hospital for examination at any time. If there are no special circumstances, you can go to the hospital for a review after 1 to 2 courses of treatment so that the doctor can adjust the treatment plan according to the changes in the condition. You should also insist on regular review for 2 years after treatment.
Early detection of abnormal vision in children
Some early vision abnormalities in children may go unnoticed because they cannot express themselves. However, children with eye diseases have many special manifestations, and parents or teachers can detect some serious eye diseases at an early stage if they observe carefully. Specific attention and observation can be made in the following areas.
Parents should pay attention to whether their children have strabismus, i.e., two eyes in abnormal position to each other, such as crossed eyes (internal strabismus), exotropia, upward strabismus, etc. If you find that your child has strabismus, you need to treat it as soon as possible.
2, whether often squinting; poor vision of the child, often through squinting to try to improve vision to see things clearly.
3, pay attention to the child’s usual vision, watching TV, there is no tilted head, squinting and other situations. Will reading and watching TV be very close, if there are these conditions, the child’s vision may be bad and need to rule out the presence of refractive error (farsightedness, myopia, astigmatism, etc.). Once this is found, go to the hospital eye examination as soon as possible to correct the refractive error to prevent amblyopia.
4. Pay attention to any abnormalities in lid fissures and eye size. Children with congenital ptosis will be unable to open their eyes for many days after birth.
As soon as the problem is detected, you should see a pediatric ophthalmologist without delay. If you delay too long, you may lose the best time to treat something that is otherwise simple to treat. Now that summer vacation is approaching, parents can use their vacation to take their children to the hospital for thorough examination and treatment if abnormalities are found.