The results of the physical examination made Mr. Li break out in a cold sweat, as the visual acuity of his left eye was only 0.04. The specialist at Beijing Children’s Hospital told Ms. Li that her child was suffering from severe amblyopia, which was mainly the result of strabismus after birth. Mr. Li did not understand why his child was suffering from amblyopia and asked us what was wrong with amblyopia. We also encountered many parents with similar questions in our clinic. In order to help parents better understand the seriousness and danger of amblyopia, we have carried out this special topic on amblyopia, hoping to help parents better understand the disease and be able to detect it early and better cooperate with the treatment to achieve better treatment results.
I. What is amblyopia?
Yu Gang, director of ophthalmology at Beijing Children’s Hospital, introduced amblyopia as a condition in which there is no obvious organic lesion in the eye and the corrected visual acuity is less than 0.9. At present, China’s amblyopia standard for corrected visual acuity ≤ 0.8 or the difference in visual acuity between the two eyes ≥ 2 lines. Amblyopia is an eye disease that seriously endangers the visual function of children. If amblyopia in children is not detected and treated early, it will lead to low vision in one or both eyes, seriously affecting binocular vision and leading to fusion loss and stereo blindness. Amblyopia, however, is a curable disease if it occurs during the sensitive stage of visual development.
How can parents detect amblyopia in their children early?
Yu Gang, Director of Ophthalmology at Beijing Children’s Hospital, said: Parents can detect amblyopia early by the following methods.
(a) Preschool physical examination: In general, children, especially those who grew up in kindergartens, can recognize the visual acuity table at the age of 3 after a simple visual acuity education. Parents can also purchase a standard vision chart and hang it on a well-lit wall at a distance of 5m for their children to identify. If the vision of one eye is below 0.8, the child should be taken to the hospital for further examination. It is generally believed that it is best to check no later than 4 years old.
(B) Early detection of the first signs of abnormalities. Children with amblyopia often have other manifestations besides low vision, such as strabismus, skewed head, squinting or close to the eyes, etc. Once a child is found to have strabismus, he or she should go to the hospital ophthalmology department as soon as possible for examination and diagnosis, because about 1/2 of strabismus combined with amblyopia. Other abnormalities mentioned above should also be taken seriously and checked by the ophthalmology department of the hospital to see if they are caused by eye disorders.
(c) For infants and young children who cannot cooperate with the vision check, a masking test can be done to get a general idea of binocular vision: if one eye is intentionally covered and the child is allowed to see with one eye, and if the child is quiet and cries or tears the mask when the other eye is covered (irritation phenomenon), it indicates that the vision of the uncovered eye is very poor and should be checked at the hospital as soon as possible.
Director Yu Gang reminds parents that early detection of amblyopia depends on the close cooperation of parents, kindergartens, schools and hospitals, and most importantly, parents themselves, who spend a lot of time with their children.
What are the causes of amblyopia?
Wu Qian, director of ophthalmology at Beijing Children’s Hospital, explained that there are many causes of amblyopia, which are summarized as follows: pediatric strabismus, high hyperopia, myopia and astigmatism, congenital cataract, severe ptosis, and congenital hypoplasia of the optic center and optic nerve.
There are also many ways to classify amblyopia, and depending on the cause amblyopia can be classified as
Strabismic amblyopia: Patients have or have had strabismus with amblyopia, but no fundus abnormalities. It is believed that this is because strabismus causes diplopia and visual disturbances that make the patient feel extremely uncomfortable, and the visual cortex of the brain actively inhibits the visual impulses transmitted from the macula of the strabismus, and the macular function of the eye is suppressed for a long time, resulting in amblyopia. This is the reason why Toto’s children suffer from amblyopia as we mentioned earlier. This kind of amblyopia is a consequence of strabismus, which is secondary and functional and therefore reversible, and the prognosis is good. Occasionally, however, a few primary cases do not improve significantly even with aggressive treatment.
Refractive parallax amblyopia: Due to the unequal clarity of the images formed in the macula of the two eyes, even if the refractive error is corrected, the size of the images caused by refractive parallax is still unequal, which makes it difficult or impossible to fuse the images of both eyes into one, and the visual cortical center can only suppress the images of the eyes with refractive error, which results in amblyopia over time, which is also functional and therefore reversible.
Formal deprivation amblyopia: In infancy, due to corneal clouding, congenital cataract, or ptosis blocking the pupil, the light stimulus cannot fully enter the eye, depriving the macula of the opportunity to receive normal light stimulation, resulting in functional impairment and amblyopia.
Congenital amblyopia: The pathogenesis is not well understood.
Noorden speculated that newborns often have retinal or optic pathway hemorrhages that may affect the normal development of visual function. Some congenital amblyopia is secondary to nystagmus.
Refractive amblyopia: Mostly bilateral, it occurs in patients with high refractive error who have not worn corrective lenses and have equal or similar visual acuity in both eyes; refractive amblyopia is most often seen in people with hyperopic refractive error. This type of amblyopia has similar binocular vision and no binocular image fusion disorder, so it does not cause macular function inhibition, so after wearing suitable corrective glasses, vision can be gradually improved without special treatment, but it takes a long time.
On the surface, the above five types of amblyopia are all amblyopia, but there are essential differences in the pathogenesis. Strabismus and refractive amblyopia have the same light stimulation into both eyes, and the macula of both eyes are involved in the development of visual function, so the prognosis is better. However, form-deprived amblyopia is a condition in which the visual function has not yet developed to a perfect or mature stage during infancy and early childhood, and the retina does not receive enough light stimulation to fully participate in the developmental process of visual function, resulting in amblyopia. The consequences of monocular disorders are more serious than those of binoculars. Therefore, special care should be taken when covering the eyes of infants and children due to eye diseases to avoid the formation of deprivation amblyopia (especially for children within 6 months).
Director Wu Qian concluded that the prognosis for congenital and form-deprived amblyopia is poor. Refractive error, strabismus and refractive amblyopia have a better prognosis. The key is early detection, timely and correct treatment, and most of the visual acuity can be improved, and the possibility of obtaining normal vision is quite high.
What is the difference between amblyopia and myopia?
Director Yu Gang explained: We have many parents who came to the clinic because they found that their children’s vision was not good and mistook their children for myopia. In fact, amblyopia and myopia are not a disease at all. Myopia tends to occur in school-age and adolescents, is due to the eye adjustment muscle ciliary muscle over tension or genetics and other reasons caused by the eye axis becomes long to see far unclear, see near clear eye disease, and the child wears a mirror corrected vision can be restored to normal; while amblyopia is mostly seen in preschool, myopic eyes, and amblyopia is a visual function development delay, disorder, often accompanied by strabismus, high refractive error, wear a mirror vision can not be corrected to The eye disease is normal. The vision is not good at distance and near. There is a fundamental difference between the two diseases.
Director Yu Gang emphasized that amblyopia is much more harmful to children’s visual function than myopia. Because myopia is only a loss of vision when looking at distance, not accompanied by other visual function damage, vision correction is not limited by age; while children with amblyopia not only have low vision, can not be corrected, but also affect the development of binocular visual function, may not have binocular monocular function, no stereo vision, the future can not be competent driving, mapping and fine work, not only affect the future of work, but also directly affect the quality of our population.
Five, amblyopia can be cured, what age is the best treatment period?
Director Wu Qian answers: The factors that may affect the effect of amblyopia treatment are: family history (amblyopia or/and strabismus), infantile diseases, type of amblyopia, original visual acuity, refraction, type and degree of strabismus, age of first diagnosis and nature of gaze. It has been clinically proven that the original visual acuity of the amblyopic eye (the milder the amblyopia, the higher the efficacy) and therefore whether amblyopia can be cured are related to many of these factors.
Many parents think that amblyopia should be treated when the child is older, because the child will know better and the treatment will be easier to cooperate. This is because children’s visual function is unstable during their visual development, and they are prone to both amblyopia and normalization. Some studies have shown that the critical period is within 2 years old, the sensitive period is before 6-8 years old, the treatment effect is extremely poor after 10 years old, and it is almost hopeless to treat after 12 years old. The treatment of amblyopia is not an overnight matter, but a long-lasting battle. Preschool children have more time to cooperate with the treatment, and some treatment after school will be affected by learning, which often makes the treatment difficult and affects the efficacy.
How is amblyopia treated? What are the common treatment methods?
Director Yu Gang introduced: The key to amblyopia treatment is accurate optometry, children also need to dilate the pupil for optometry, wearing appropriate glasses, on the basis of this treatment, the main methods include the following: (1) traditional masking method + traditional masking method
(1) Traditional masking method + fine vision homework: cover the eye with good vision, force the amblyopic eye (the eye with poor vision) to see, and do fine vision homework at the same time, such as: training with amblyopic inserts to stimulate the development of the optic nerve system, so that the amblyopic eye vision improves. This method is simple and easy to implement, and is suitable for strabismic amblyopia and refractive parallax amblyopia with reliable results.
(2) Brain imaging network amblyopia treatment, which is the latest neuro-vision treatment technology, there is a special introduction to this treatment method on our website.
http://www.baobaoeye.com/Article/etybin/rtruoshi/200506/74.html
(3) Amblyopia Therapy http://www.baobaoeye.com/Article/etybin/rtruoshi/200605/226.html/
http://bch.eyeinfo.cn/rshjinshi/Index.html
(4) Visual stimulation therapy (i.e., CAM stimulator): The use of contrasting bars with different spatial frequencies as a stimulation source to stimulate the amblyopic eye to improve visual acuity. This method is simple and easy to implement, each treatment time is short, quick results, especially for refractive amblyopia, and other suppression therapy, after image therapy, etc.
(5) Red light flicker therapy
(6) Multimedia optical disc training
For amblyopia caused by strabismus, congenital cataracts and ptosis, surgery should be actively used to treat these eye diseases, and the child should be given a timely postoperative optometry to determine whether to wear glasses. In particular, after congenital cataract surgery, glasses are needed to solve the adjustment problem of seeing far and near, and glasses are worn for life.
Amblyopic children with combined strabismus like Duo should be treated first for amblyopia and then for strabismus. For those with congenital strabismus, surgery is performed to correct the strabismus first, followed by amblyopia training. For amblyopia with combined high number strabismus, amblyopia should be treated first for a period of time, and then surgically correct the strabismus after the visual acuity is partially improved and the eye position is corrected before continuing to treat the amblyopia.
Director Yu Gang specifically mentioned that parents’ care and active cooperation are related to the success or failure of amblyopia treatment. If the parents can comply with the doctor’s orders, attend medical appointments on time, supervise the child to complete homework well, and report any problems in time, they are all beneficial and necessary measures to promote successful treatment.
How can parents cooperate in the treatment of amblyopia?
Director Yu Gang further introduced.
Amblyopia treatment does not happen overnight. In addition to the doctor’s examination and guidance, active cooperation of the child and parents is needed, otherwise, not only half the effort is needed, but also the treatment may be abandoned halfway.
The treatment of amblyopia is inseparable from the cooperation of parents, in the treatment, parents should do the following.
(1) After the glasses are prepared, you must supervise your child to insist on wearing them, and regularly re-examine the pupils according to medical advice.
(2) Some children are reluctant to adhere to the treatment because of the teasing and nicknames of the children around them after the masking treatment, or they put on the eye patch in front of their parents and take it off behind their backs, making their parents totally unaware of it. This is often the reason why the treatment is not effective. In such cases, it is important to educate the child patiently and convince him or her to adhere to treatment consciously. It is also necessary to contact the teachers and ask them to do a good job with the children and urge them to adhere to the treatment.
(3) While wearing glasses and masking treatment, it is important to strengthen the training of fine work. Correct the misconception that too much eye use makes vision decline. In fact, the more you use your amblyopic eye, the faster your vision will improve. In addition to supervising the child to complete the training on time, parents can often change the new form, homemade or purchase some auxiliary treatment apparatus to improve the interest of the child training.
(4) If optical drug suppression therapy is used, in addition to insisting on wearing glasses, the pupil should be dilated with the prescribed concentration of atropine eye solution according to the doctor’s prescription and on time.
(5) Parents should bring the child to the hospital for follow-up examinations regularly as prescribed by the doctor, and bring the medical records of the examinations and treatments for the doctor to determine the efficacy and adjust the treatment plan at any time. Generally, the child should be seen once a month. Six months after the normalization of visual acuity, monthly follow-up is still required to prevent the recurrence of amblyopia, and then gradually changed to 3 months or half-yearly follow-up, until the visual acuity remains normal for 3 years, then amblyopia is completely cured.
How to treat amblyopia at home?
Director Yu Gang reminds parents that amblyopia treatment at home is mainly carried out in the following ways.
(a) Insist on wearing glasses every day
(ii) Using amblyopia treatment device
Once or twice a day.
(iii)
Covering both eyes alternately according to the visual acuity, e.g.
a) Both eyes have the same visual acuity, alternate masking in both eyes: three days for the right eye, three days for the left eye, and one day on Sunday when the masking is removed from both eyes.
b) Two lines of difference in visual acuity between the eyes, four days for the right eye and two days for the left eye, with one day of removal of coverage for both eyes on Sunday.
c) Four rows of difference in visual acuity in both eyes, five days in the right eye and one day in the left eye.
Remove the mask for one day on Sunday
d) Low vision in one eye, normal vision in the other eye, total masking of the right eye, and removal of masking of both eyes for one day on Sunday.
(d) The above masking is only a principle, and the doctor should decide according to the patient’s condition.
(v) Masking must be strict to prevent the child from peeking and failing to achieve the purpose of treatment.
(vi) Children with strabismus, as both eyes open at the same time, the strabismic eye will cause new inhibition and interference, so children with apparent strabismus, Sunday do not need to open both eyes at the same time, just continue to cover both eyes alternately according to the ratio can be.
(vii) Homework.
a) Younger children should string beads and put on buttons, 100 per day/one eye.
b) Older children should be trained in threading needles, 100 per day / one eye.
c) You can also assist with checkers, tracing, vision insertion board and other fun amblyopia training.
d) For children with severe amblyopia and older children, 200 needles per eye per day.
(viii) Homework children can be assisted with multimedia amblyopia CD training treatment at the same time.
(ix) Every six months, the doctor will decide whether to adjust the prescription of the glasses according to the changes of the child’s glasses.
It is best to take the child to the hospital for specific treatment and ask the doctor to give guidance according to the child’s visual acuity and the specific circumstances of the treatment.
Nine, the treatment of amblyopia why do we need to wear glasses?
Director Wu Qian explained: As mentioned earlier, amblyopia is often accompanied by refractive error, and the examination of amblyopia must be dilated, the purpose is to accurately detect the actual refraction, in order to match the appropriate glasses. And amblyopia only in wearing glasses to correct refractive errors based on the same time amblyopia training, so that clear images repeatedly stimulate the retinal gaze center, improve visual sensitivity, it is possible to improve vision, so the treatment of amblyopia must wear glasses.
Ten, amblyopic children wearing glasses to pay attention to what?
Wu Qian, the director of the answer: prescription lenses must be dilated, to the optician’s glasses according to the different pupil distance to choose the appropriate frame. It is best to go to the hospital after the glasses are dispensed to check whether the prescription is the same as the prescription with the instrument.
The glasses must be worn consistently after the prescription is made, without interruption. The first time you wear glasses to treat amblyopia, your vision does not improve much, and some people’s vision decreases after wearing glasses, especially in the case of medium and high farsighted glasses, which is normal. Wearing glasses requires a period of adaptation process, as long as you insist on wearing glasses, vision will gradually improve.
Regularly re-dilate the pupil and adjust the prescription. Children with amblyopia are developing and the refractive error of both eyes changes with age, so you can’t wear a pair of glasses all the time without changing them. Generally, children under the age of 3 should have their pupils re-examined every six months, and children over the age of 4 should have their pupils re-examined every year.
Children over the age of 4 will have their pupils dilated once a year, and each time, depending on the change in refractive error and the correction of amblyopia and strabismus, they will decide whether to change their glasses again.
Eleven, amblyopic children wearing glasses can still be taken off?
Director Wu Qian explained: this issue is also a common concern of parents of children with amblyopia, in fact, most of the glasses of children with amblyopia can be removed when they grow up. This is because the amblyopic child later combined with hyperopia is common, and as the amblyopic child grows older, the eye development, hyperopia will gradually reduce, the degree of glasses will also be reduced, vision gradually returned to normal, glasses off. Of course, children who are cured of amblyopia will need myopia glasses again if they do not pay attention to eye hygiene during development.
There are also children with amblyopia who need to wear glasses for life, but this is a very small percentage. This type of amblyopia is often combined with high hyperopia of +6.00D or more and astigmatism of ±2.00D or more. Even with age, the development of the eye cannot compensate for the serious refractive abnormalities, so glasses are still needed to correct vision in adulthood.
Director Wu Qian added: If amblyopia is treated in time during childhood and vision can be corrected in these eyes, although adults still need to wear glasses, it is much better than not corrected at a young age, and when you want to get glasses as an adult, you can’t.
What are the criteria for curing amblyopia?
Director Yu Gang introduced: according to the Chinese Medical Association, the Chinese Society of Ophthalmology, the National Children’s Amblyopia and Strabismus Prevention and Control Group in September 1987, the evaluation criteria for the efficacy of amblyopia treatment are
(1) Ineffective: including those whose visual acuity regresses, remains unchanged or improves by only one line.
(2) Progress: visual acuity improvement of two or more rows.
(3) Basic healing: those whose visual acuity has recovered to ≥0.9.
(4) Cured: After 3 years of follow-up, the visual acuity remains normal.
Note: If there is a condition, you can receive other visual function training at the same time, in order to fully restore the monocular function of both eyes.
At present, the overall cure rate of amblyopia treated with comprehensive therapy in China is about 80%, and 81.07% of the cases have established stereopsis.
The effectiveness time of amblyopia treatment is closely related to the type of amblyopia, age, degree, treatment method and the degree of cooperation with treatment. In general, those who are ineffective after 6 months of treatment can be considered to have poor results.
Can amblyopia treatment be stopped after the eye has recovered from treatment?
Director Yu Gang explained: After the treatment of amblyopia, the vision of children returns to normal, and many parents think that they can stop the treatment from then on, which is wrong. The restoration of normal visual acuity in the amblyopic eye is only the first step of treatment, and later there is training for monocular, fusion and stereo vision in both eyes.
The number of treatments can be gradually reduced, and the density of treatment can be scaled down, regularly observed, and amblyopia treatment can be gradually stopped.
The treatment can also be maintained through brain imaging network therapy.
Why do some children relapse after amblyopia treatment? What are the main causes of amblyopia recurrence?
Answer: The main reason for recurrence is that the patient does not follow the doctor’s instructions and opens the eye on his own for 2 hours a day before the normal vision is consolidated, and after 1 month, if the effect is consolidated, the opening time is extended to 4 hours a day, and later to 6 hours, 8 hours, until the whole day is opened. Translucent paper or plastic film can also be used to cover the lens of the healthy eye or to smear the lens with nail polish so that the vision of the healthy eye is two lines lower than that of the amblyopic eye in order to maintain the vision obtained in the amblyopic eye. Overcorrected or undercorrected lenses or the use of alternating suppression methods can serve to maintain and consolidate the vision of the amblyopic eye.
Director Wu Qian tips: If the amblyopic eye vision does decline, can then cover the healthy eye, the amblyopic eye vision can be improved to the original highest level, and the speed of improvement is faster than before the restoration method. At the same time, the monocular function training of both eyes will be strengthened to consolidate the treatment effect. The follow-up period will be once a month for the first 6 months and once every 6 months until 2 years.
15. How to prevent recurrence after amblyopia is cured?
Director Yu Gang reminded parents that in order to prevent recurrence of amblyopia, the following points should be noted.
(1) Covering therapy should be removed gradually after the vision returns to normal. First, open it for 2 hours a day, and then extend the opening time to 4 hours a day after 1 month, and later to 6 hours, 8 hours, until full day opening or change from full to half masking to consolidate the effect. During the consolidation period, no relaxation of fine work.
(2) After normal vision, the first 6 months need to be reviewed once a month, later to 3 months, half a year, until the follow-up follow-up 3 years until the complete cure.
(3) If the amblyopic eye is found to have decreased visual acuity, the healthy eye can be re-covered and the amblyopic eye can still be improved to the original level.
(4) In addition to vision enhancement therapy for strabismic amblyopia, efforts should be made to train the monocular function and fusion power of both eyes. If it is found that the visual acuity decreases, the posterior image therapy should be resumed. The posterior image therapy should not be stopped suddenly, but should be gradually reduced in number and extended interval and stopped slowly, and after it is stopped, the amblyopic eye should be often used to watch movies, TV, write small words, do fine work, or do drawing games on the carousel painted with black and white lines, through these simple and easy methods to stimulate the macular function and prevent regression.
(4) For strabismic amblyopia, in addition to vision enhancement therapy, efforts should be made to train the monocular function and fused image power of both eyes. If it is found that the visual acuity decreases, the posterior image therapy should be resumed. The posterior image therapy should not be stopped suddenly, but should be gradually reduced and the interval should be extended and stopped slowly, and after stopping, the amblyopic eye should be often used to watch movies, TV, write small words, do fine work, or do drawing games on the carousel painted with black and white lines, through these simple and easy methods to stimulate the macular function and prevent regression.