Amblyopia is a common disease in children’s visual development, with a prevalence of 2% to 4% in China. Amblyopia refers to the absence of organic disease in the eye, corrected visual acuity below 0.9, and mainly manifests as low visual acuity and monocular dysfunction in both eyes. Amblyopia in children is often accompanied by other symptoms such as strabismus, refractive error, and high refractive error.
The cause of childhood amblyopia is that during infancy, children fail to receive appropriate visual stimulation due to perceptual, motor, conduction and central reasons, which affects visual development and results in diminished visual function. There are many kinds of amblyopia, and amblyopia in our children is mainly caused by refractive error, especially hyperopic refractive error. Children with amblyopia not only have low visual acuity, but also have no perfect stereo vision, which will have an impact on their future education and career choice, therefore, parents must pay attention to the early detection and treatment of amblyopia in children.
Generally speaking, most children can be cured if they are treated appropriately during the child’s visually sensitive period (around 6 years old). Currently, Shanghai has established an initial early childhood health care network, and child health care doctors can detect children with amblyopia through screening in kindergartens. In addition, there are easy ways for parents to assess whether their child has amblyopia.
The specific methods are.
1. Place a more visible object in front of the child’s eyes and observe whether he can detect it in time.
2. After changing the direction of the object, observe whether the child has a follow-through response. (You can choose a group of items from large to small, and the placement should be from near to far).
3.Observe the child’s situation when he looks at both eyes and one eye, and notice whether he likes to come close when watching TV.
4.When the child looks at something, there is no abnormal head position, such as whether he likes to look up or down.
5. Whether the child can gaze steadily when looking at objects. If the child’s eyeballs turn back and forth or tremble, there is a possibility of amblyopia.
If parents find any abnormalities in the child’s vision, please take the child to a specialist hospital immediately for examination. Generally speaking, children aged 3 to 4 years old can already be diagnosed with abnormal vision through vision chart examination.
Treatment of amblyopia begins with treatment of the cause: strabismic amblyopia should be corrected; refractive amblyopia should be treated by wearing appropriate lenses; deprivation amblyopia caused by ptosis should first be treated with surgery to correct ptosis. Then, under the guidance of a physician, fine visual acuity training should be performed at home. Children with monocular amblyopia must also be treated with masking. In addition, there are medications and therapeutic devices available.
What are the levels of amblyopia?
The Chinese Medical Association’s Ophthalmology Society established standards in 1996 that classify the severity of amblyopia into three levels.
Mild amblyopia: corrected visual acuity of 0.6 – 0.8.
Moderate amblyopia: corrected visual acuity of 0.2-0.5
Severe amblyopia: corrected visual acuity equal to or less than 0.1.
The above visual acuity includes bare eye visual acuity or corrected visual acuity after prescription. The highest visual acuity is used against the above criteria.
What are the dangers of amblyopia?
The greatest danger of amblyopia is that the child not only has poor binocular or monocular vision, but often does not have perfect binocular vision and cannot develop stereo vision. They have no sense of depth when going down stairs, no sense of stereo when looking at a microscope, etc. They cannot learn stereo geometry well, and cannot choose professions such as architecture, engineering, medicine, mechanics, or artwork. Since the brain can only receive visual signals from the unilateral input of the healthy eye, the brain is unable to form a stereo image, which will result in the patient not having the ability to imagine stereo. Just like deaf people, their articulation organs, tongue and vocal cords are normal, but they are unable to pronounce words because of deafness causing mute, their hearing impairment, resulting in the inability to imitate pronunciation and eventually losing the ability to pronounce words.
This will directly affect future employment and work, and bring great inconvenience to life, and in more serious cases, can lead to lifelong low vision, and cannot achieve normal vision even with glasses. In addition, amblyopia often causes strabismus, which affects aesthetics and physical and mental health. Children with amblyopia often suffer from low self-esteem and autism.
Why do children need dilated pupils for optometry?
Depending on the refraction, the pupil will be reviewed the next day or 3 weeks later to determine the degree of wear.
The purpose of the pupil dilatation is to paralyze the ciliary muscle, thus paralyzing the adjustment effect, so that the optometry can be correct and conducive to the treatment of amblyopia. Some parents feel that it is too much of a hassle and too long, and often ask not to have the pupil dilated. However, the eyes of children under 12 years of age are highly regulated, so if the pupils are not dilated with a diluent, the error in the prescription will be large.
What are the principles of amblyopia treatment?
With timely and proper treatment, the majority of children with amblyopia can improve their visual acuity and have a greater chance of obtaining normal vision. Most amblyopia occurs in preschool infants and young children, and the treatment of amblyopia is limited by age, the younger the child the better the effect, the older the treatment the worse the effect, and there is no hope of cure in adults. Do not think that amblyopia is not a disease or a minor disease, or even have the illusion that the child will be able to grow up and get better on their own, and if treatment is not timely or delayed, they will be hated for life.
What are the common methods of treating amblyopia?
1, wearing glasses therapy
Wearing glasses to focus the light on the macular area of the retina, so that the image is clear and the visual function can be developed normally.
2.Masking therapy
Covering the healthy eye, forcing the amblyopic eye to gaze, eliminating the inhibition of the healthy eye on the amblyopic eye.
3.Common vision training therapy
Separate the two eyes, each eye looks at an object, and fuse the object images of the two eyes into one in the cerebral visual cortex to establish and improve stereo vision.
4.Suppression therapy
The use of optics and drugs to temporarily inhibit the healthy eye, so that the healthy eye becomes blurred, thus facilitating the activation of the amblyopic eye, gradually lifting the competitive inhibition of the amblyopic eye, vision can also be gradually improved.
5.Multi-frequency red light flicker therapy
According to the characteristic that the cone cells in macular area are most sensitive to 640nm wavelength light, the light of special red filter (wavelength 640nm) is used to stimulate the cone cells in the central recess of the macula of retina to promote visual development.
6.CAM grating visual stimulation therapy
Using different frequencies of black and white grating as the best visual stimulation source, so that the amblyopic eye in all directions both by different spatial frequency of stimulation, but also by the contrast of the grating stimulation, so that the visual cells to enhance the development and improve visual acuity.
7.Fine vision training method
Consciously forcing the amblyopic eye to focus on small targets, so that the inhibited photoreceptor cells in the amblyopic eye are stimulated to lift the inhibition and improve the perception of the visual center.
8.Heidinger light brush therapy
By rotating the blue polarized glass plate to gaze at the strong light, you can continuously see the light brush with different widths of shadow, stimulating different types of cells in the macular center, eliminating the inhibition and reconstructing the interconnection, and achieving effective treatment.
9.Posterior image training therapy
A small circular black piece in the center of the posterior image light source is used to cover the central macula, so that the strong light is irradiated on the retina, which eliminates the inhibition of the macula by the visual center and relatively improves the gaze of the central macula, so that the paracentral gaze is transferred to the central gaze. (Especially suitable for paracentral amblyopia)
Can amblyopia be cured? What is the best age for treatment?
The following factors may affect the prognosis: family history (amblyopia or/and strabismus), infantile disease, type of amblyopia, original visual acuity, refraction, type and degree of strabismus, age of first diagnosis and nature of gaze. It was clinically proven that the original visual acuity of the amblyopic eye (the lighter the amblyopia, the higher the efficacy), the nature of gaze (the efficacy of central gaze is much better than that of paracentral gaze) and the age of treatment (the younger the better) have significant effects on the efficacy, while family history and the presence or absence of strabismus have little relationship with the efficacy. In addition, binocular orthophoria with good binocular monocularity is the most important factor to ensure and consolidate the efficacy.
Therefore, whether amblyopia can be cured or not is related to many factors mentioned above, among which the efficacy of amblyopia treatment is closely related to age, the younger the child, the better the treatment effect, and the treatment is hopeless in adults. This is because children’s visual function is unstable during the visual development period, which means that amblyopia can easily occur and also easily return to normal. After the age of 13, children’s visual function is already well developed, and if they are treated at this age, their visual acuity will not be easily improved, and fine stereo vision will not be established.
Therefore, the best time to treat amblyopia is between the ages of 1 and 5 during the visual development period. Moreover, the treatment of amblyopia is not an overnight matter, but a constant battle. Preschool children have more time to cooperate with the treatment, and some treatments after school will be affected by learning, which often makes the treatment difficult and affects the efficacy.
What are the criteria for curing amblyopia? How long does it take for treatment to be effective?
According to the criteria for evaluating the efficacy of amblyopia treatment developed by the Chinese Medical Association, the Chinese Society of Ophthalmology, and the National Group for the Prevention and Treatment of Amblyopia and Strabismus in Children in September 1987, the following are the criteria
1.Ineffective: including those whose visual acuity regresses, remains unchanged or improves by only one line;
2.Progress: those with two or more lines of visual acuity improvement;
3.Basic cured: those whose visual acuity has recovered to ≥0.9;
4.Cured: After three years of follow-up, the visual acuity remains normal.
Note: If there are conditions, 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 people 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 as having poor results.
Estimates of the duration of treatment are: one month for central fixation, about 2 months for non-central fixation, one month at the shortest and one year at the longest. The average is about 5 months. For monocular hyperopic amblyopia and strabismic amblyopia, generally within 3 months, up to 50% of the patients can achieve the best visual acuity.
Although amblyopia treatment is effective at a young age, children and adolescents under the age of 15 who are diagnosed late should not give up the treatment easily and will receive some results from active treatment.
How to prevent the recurrence of amblyopia after it is cured?
At the early stage of amblyopia cure, the child’s vision is not consolidated, and some children have the possibility of recurrence and vision loss again. The main reason for the loss of vision is that these patients fail to establish monovision in both eyes and adequate integration, which can lead to recurrence of amblyopia for several reasons: parents and children discontinue treatment on their own after their vision has improved to normal and before it has been consolidated; premature removal of the mask, which opens both eyes; amblyopia is cured and strabismus surgery is performed in a hurry, and the operated eye (amblyopic eye) is covered for too long after surgery; regular follow-ups are not performed and the cured eye is neglected. The amblyopic eye’s visual acuity changes after cure.
In order to prevent recurrence of amblyopia, the following points should be noted.
1. Covering therapy should be removed gradually after the vision has returned to normal. First, open 2 hours a day, after a month of consolidation, then extend the opening time to 4 hours a day, and later to 6 hours, 8 hours, until the full day open or from the full cover to half cover consolidation effect. During the consolidation period, no relaxation of fine work.
2.The first six months after normal vision need to be reviewed once a month, later to three months, half a year, until the follow-up review three years until completely cured.
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 high level.
4.In addition to vision enhancement therapy for strabismic amblyopia, efforts should be made to train the monocular function of both eyes and image integration. 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 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.
What are the causes of amblyopia recurrence?
After a period of treatment, the vision of amblyopic children improves to 0.9 or above in both eyes, but after a period of time, the vision of one or both eyes drops to below 0.9 again, which is often called “amblyopia relapse”. The reasons for relapse should be considered from the following three aspects.
Family factor: Some parents think that their children’s vision has been restored and neglect consolidation treatment, do not supervise their children to continue amblyopia training, do not regularly check their vision, optometry and change glasses.
Factors of the child: Due to poor self-awareness, children do not insist on wearing glasses and cannot adhere to the treatment. Some children wear glasses only in front of their parents and not when they leave them.
Doctor factor: For children with strabismic amblyopia after strabismus surgery, the amblyopic eye may relapse because it has been covered for too long.
What is the difference between amblyopia and myopia?
Amblyopia and myopia are not at all the same disease. Myopia is an eye disease in which the eye axis becomes longer due to excessive tension in the ciliary muscle or genetics, and the vision is not clear in the distance but clear in the near. The two diseases are fundamentally different, as their visual acuity cannot be corrected to normal with glasses.
Amblyopia is much more harmful to the visual function of children than myopia. Because myopia is only vision loss when looking at the 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, it is impossible to have binocular monovision, 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.
How can parents cooperate in amblyopia treatment?
Amblyopia treatment does not happen overnight. In addition to the doctor’s examination and guidance, it requires the active cooperation of the child and parents, otherwise not only half the effort is needed, but also half the effort may be lost.
Some parents do not know enough about the nature and severity of amblyopia, and lack confidence in long-term treatment, and lose confidence in the slow progress of vision after treatment for a period of time, so that the child is left to its own devices, to be aware of the seriousness of amblyopia and then regret the first, the result of turning back to re-treatment, not only wasting time, but more importantly, miss and the best time for treatment, affecting the effectiveness of treatment; other parents are busy with work, children’s homework tight, can not be the reason. Some parents cannot insist on taking their children to the hospital for checkups because they are busy with work and schoolwork, and they lose the precious time for treatment.
This shows that the treatment of amblyopia can not be separated from the cooperation of parents, in the treatment, parents should do the following: 1.
1, after the glasses are dispensed must urge the child to adhere to wear, and according to medical advice regular re-diagnosis examination.
2, some children because of masking treatment caused by the surrounding children to make fun of, take nicknames, thus reluctant to adhere to treatment or in front of parents to wear eye patch, behind and take off, so that parents are completely unaware. 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 the 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 necessary to strengthen the training of fine work. Correct the wrong view that too much eye use makes vision decline. In fact, the more the amblyopic eye is used, the faster the visual acuity improves. In addition to supervising the child to complete the training on time, parents can often change new forms, homemade or purchase some auxiliary treatment apparatus to improve the child’s interest in training.
4, such as the use of optical drug suppression therapy, in addition to insist on wearing glasses, should be punctually ordered according to medical advice with the prescribed concentration of atropine eye solution to dilate the pupil.
Parents should bring their children to the hospital regularly for follow-up examinations as prescribed by the doctor, and should 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 follow-up examination should be held once a month. Six months after normalization of visual acuity, monthly follow-up is still required to prevent recurrence of amblyopia, and then gradually changed to once every three months or six months, until visual acuity remains normal for three years, amblyopia is considered completely cured.
What should I pay attention to when wearing glasses for amblyopic children?
Amblyopic eyes need to pay attention to the following aspects when wearing glasses.
You must go through a dilated eye exam when getting glasses. It is best to go to a hospital for professional optometry. After the glasses are ready, you must insist on wearing them, not to interrupt. The first wear treatment amblyopia glasses vision does not improve how much, and even some glasses after the vision but decreased, especially in the high farsighted glasses, these are normal circumstances. 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 3 years old should have their pupils dilated once, and children over 4 years old should 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 should decide whether to change their glasses again.
Can children with amblyopia still take off their glasses?
This is a common concern among parents of children with amblyopia. In fact, most children with amblyopia can remove their glasses when they grow up. This is because amblyopic children are more likely to have hyperopia, and as the amblyopic child grows older and the eye develops, the degree of hyperopia will gradually decrease, the degree of the glasses will also decrease, and the vision will gradually return to normal, and the glasses will be removed. 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 as they grow older, the development of the eye cannot compensate for the serious refractive abnormalities, and they still need to wear glasses to correct their vision as adults.
If the amblyopia is treated in time during childhood and the vision can be corrected, although adults still need to wear glasses, it is much better than not correcting it at a young age and not being able to get glasses as an adult.
What is the nutritional regimen for children with amblyopia?
The effectiveness of amblyopia is determined by many aspects, of which the role of nutrition is also an important aspect. According to research, ginseng, Shou Wu, Chinese wolfberry and animal brain, etc., really help the human brain cell development, strong nerves, strengthen the body, and promote the role of the mind and eyes clear. Calcium, magnesium, phosphorus, glutamic acid, vitamin B complex and B12, etc., are indispensable substances for the education of bright eyes. Egg yolk is rich in lecithin and acetylcholine, which are beneficial for promoting brain function and intellectual development, enhancing memory and improving vision. Glutamic acid, known as “wisdom acid”, is an important part of the human brain needs to eliminate the poisonous effects of “ammonia” in brain metabolism, and is high in fresh milk, fresh liver and beer, and is rich in B-complex vitamins, all of which are foods that promote the wisdom of the human brain. Amblyopic children must be given adequate nutrition, in fact, the most important thing is to prevent children from partiality and picky eating, food should be diversified, meat and vegetables, regular ration. The following is a brief introduction to some of the nutrients in food.
Foods containing calcium: shrimp, kelp, soybeans, vegetables, milk, peanuts, oranges, oranges and egg yolks, etc.
Foods containing vitamin A: pig liver, chicken liver, egg yolk, milk, goat milk, etc.
Foods containing riboflavin: milk, cheese, lean meat, eggs, yeast and lentils, etc.
Foods containing chromium: brown rice, corn, brown sugar, etc. In addition, lean meat, fish, eggs and radish and beans also contain certain amount.
Foods containing vitamin C and B: fresh dates, citrus, tomatoes, potatoes, meat, animal liver, kidney and dairy.
Alkaline foods: citrus, apples, kelp and fresh vegetables, etc.
Foods containing caffeine: tea, coffee and chocolate, etc.
Foods containing zinc: oysters, beef, beef liver, pork, eggs, peanuts, walnuts, potatoes, cucumbers, carrots, tomatoes, apples, etc.