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Optimal Timing for Amblyopia Treatment

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Should we treat amblyopia before, during, or after addressing its cause?
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In this blog, we will discover the optimal timing for amblyopia treatment. Furthermore, we will address different types of lazy eye and how the timing of the treatment differs.

Challenges in Amblyopia Treatment from Visual Deprivation

Amblyopia or lazy eye is a disorder that ensues following certain ocular abnormalities. Those are (A) refractive errors, (B) eye misalignment, and (C) visual deprivation.

Most commonly, amblyopia arises due to unrecognized refractive errors such as anisometropia, followed closely by eye misalignment in the form of strabismus. Click on the links above to read our detailed descriptions of anisometropic amblyopia and strabismus, respectively.

The third wider cause of amblyopia development is visual deprivation, with congenital cataract, congenital ptosis, or other rare ocular abnormalities as potential causes.

Emphasizing Early Causal Treatment for Severe Deprivation Amblyopia

It is important to note that most cases of amblyopia are caused by either refractive errors or strabismus, and that cases of deprivation are rare.

Nonetheless, visual deprivation in early infancy, regardless of the cause, usually results in very deep amblyopia. Such amblyopia does not respond well to conventional treatment. Therefore, appropriate causal treatment (e.g., cataract extraction or ptosis correction) should be initiated soon and prior to any other interventions. In severe deprivation amblyopia, then, the cause should be treated before the amblyopia itself.

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Navigating Complexity: Amblyopia Treatment Challenges in Anisometropic and Strabismic Cases

Conversely, in cases of anisometropic and strabismic amblyopia, the answer may not always be that straightforward. What is more, these two represent the majority of amblyopia cases.

As we have discussed extensively in some of our previous blogs, the goal in amblyopia treatment is the improvement of monocular visual acuity as well as binocular visual function – stereovision.

Tailoring Treatment for Anisometropic Amblyopia: Beyond Refractive Correction

In anisometropic amblyopia, the causal refractive correction is often all that is needed as many children respond well to that alone. It leads to the improvement of monocular as well as binocular visual function.

Some, however, will not respond well to correct refractive correction alone and will require a form of specific amblyopia treatment, usually occlusion, in combination with vision training for maximum effect.

Surgical Correction of Strabismus – Before or After?

In strabismic amblyopia, though, things are usually a bit more complicated.

In severe eye misalignment, conventional amblyopic interventions such as occlusion and vision training will usually improve monocular visual acuity, but they will fail to improve stereovision to the desired degree. Therefore, special prism glasses or even surgery will sometimes be needed even before, or during amblyopia treatment.

Conclusion

The truth is, though, that there is no definite answer to whether amblyopia should be treated before, during, or after addressing its cause. It very much depends on the cause, the severity of the cause and the individual. Any form of severe deprivation sure must be addressed before, as should the unrecognized refractive errors. In severe strabismus, on the other hand, the decision whether to correct the squint before, during or after amblyopia treatment lies with the attending physician. Remember, your child’s doctor always knows what is best for you kid!

Frequently Asked Questions

How does amblyopia impair the eyes?

Amblyopia or lazy eye is a disorder that ensues following certain ocular abnormalities, namely refractive errors, eye misalignment, and visual deprivation.

What is the best time to treat amblyopia?

Amblyopia should be treated as soon as it is discovered, ideally during early childhood when the brain is still developing. Early intervention increases the chances of successful treatment. While treatment can still help older children and adults, it may not be as effective as when initiated early. However, with older kids and adults, compliance may represent an advantage to the treatment.

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