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Home » What's New » Are You Missing Your Child’s Hidden Vision Problem?

Are You Missing Your Child’s Hidden Vision Problem?

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Your toddler may show every sign of good eyesight including the ability to see objects in the distance, however that doesn't necessarily mean that he or she doesn't have a vision problem.

Amblyopia is one common eye condition that is often hidden behind the appearance of good eyesight.  

Also known as "lazy eye" it usually occurs when the brain begins to ignore the signals sent by one eye, often because that eye is weaker and doesn't focus properly. Sometimes it can occur in both eyes, in which case it's called bilateral amblyopia. This eye condition is especially common in preemies, and tends to run in families as well, so it's important to provide your eye doctor with a complete medical and family history.

There are several factors that can cause amblyopia to develop. These include:

  • astigmatism, 
  • high nearsightedness or farsightedness, 
  • uneven eye development as an infant,
  • congenital cataract (clouding of the lens of the eye),
  • strabismus (where the eyes are misaligned or "cross-eyed")

However in many cases of amblyopia there may be no obvious visible structural differences in the eye. In addition to the fact that the eyes may look normal, vision often appears fine as the brain is able to compensate for the weaker eye by favoring the stronger one. Because of this, many children live with their eye condition for years before it is diagnosed. Unfortunately, as a person ages, the brain loses some of its plasticity (how easy it is to train the brain to develop new skills), making it much harder - if not impossible - to treat amblyopia in older children and adults. That's why it's so important for infants and young children to have a thorough eye exam.

Are There Any Signs of Amblyopia?

If you notice your child appears cross-eyed, that would be an indication that it's time for a comprehensive eye exam to screen for strabismus and amblyopia development.

Preschoolers with amblyopia sometimes show signs of unusual posture when playing, such as head tilting, clumsiness or viewing things abnormally close.

However, often there are no signs or symptoms. The child typically does not complain, as he or she does not know what normal vision should look like. Sometimes the condition is picked up once children begin reading if have difficulty focusing on the close text. The school nurse may suggest an eye exam to confirm or rule out amblyopia following a standard vision test on each eye, though it might be possible to pass a vision screening test and still have amblyopia. Only an eye doctor can make a definitive diagnosis of the eye condition.

So How Do You Know If or When To Book a Pediatric Eye Exam?

Comprehensive eye and vision exams should be performed on children at an early age. That way, hidden eye conditions would be diagnosed while they're still more easily treatable. An eye exam is recommended at 6 months of age and then again at 3 years old and before entering first grade. The eye doctor may need to use eye drops to dilate the pupils to confirm a child's true refractive error and diagnose an eye condition such as amblyopia.

Treatment for Amblyopia

Glasses alone will not completely correct vision with amblyopia in most cases, because the brain has learned to process images from the weak eye or eyes as blurred images, and ignore them. There are several non-surgical treatment options for amblyopia. While your child may never achieve 20/20 vision as an outcome of the treatment and may need some prescription glasses or contact lenses, there are options that can significantly improve visual acuity.

Patch or Drops

In order to improve vision, one needs to retrain the brain to receive a clear image from the weak eye or eyes. In the case of unilateral amblyopia (one eye is weaker than the other), this usually involves treating the normal eye with a patch or drops to force the brain to depend on the weak eye. This re-establishes the eye-brain connection with the weaker one and strengthens vision in that eye. If a child has bilateral amblyopia, treatment involves a regimen of constantly wearing glasses and/or contact lenses with continual observation over time. 

Your eye doctor will prescribe the number of waking hours that patching is needed based on the visual acuity in your child's weak eye; however, the periods of time that you chose to enforce wearing the patch may be flexible. During patching the child typically does a fun activity requiring hand eye coordination to stimulate visual development (such as a favorite video game, puzzle, maze etc) as passive activity is not as effective. 

The earlier treatment starts, the better the chances are of stopping or reversing the negative patterns formed in the brain that harm vision. Amblyopia treatment with patches or drops may be minimally effective in improving vision as late as the early teen years (up to age 14) but better results are seen in younger patients.

Vision Therapy

Many optometrists recommend vision therapy to train the eyes using exercises that strengthen the eye-brain connection. While success rates tend to be better in children, optometrists have also seen improvements using this occupational therapy type program to treat amblyopia in adults. 

The key to improvement through any non-surgical treatment for amblyopia is compliance. Vision therapy exercises must be practiced on a regular basis. Children that are using glasses or contact lenses for treatment, must wear them consistently. Your eye doctor will recommend the schedule of the patching, drops, or vision therapy eye exercise and the best course of treatment.

Amblyopia: Take-home Message

Even if your child is not showing any signs of vision problems, and especially if they are, it is important to have an eye examination with an eye doctor as soon as possible, and on a regular basis. While the eyes are still young and developing, diagnosis and treatment of eye conditions such as amblyopia are greatly improved.

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Dear Northwood Vision patient,

COVID-19 has the potential to cause grave harm to many of the citizens in our population. According to Harvard epidemiologist Dr. Mark Lipsitch it is likely that at least between 40-70 % of the population will become infected with COVID-19. This virus is twice as contagious as the flu. About 80 percent will not have severe concerns, but based on the current data, 20% of the infected will become severe or critical, needing some form of hospital care to do well. Currently, about 30 % of those who become classified as severe based on WHO classification, will not survive. These are the unfortunate realities at the moment.

Meanwhile, at Northwood Vision, we want to do as much as possible to minimize this risk, to prevent mortality and long term side effects, while doing our best to provide the services our patients need. We are convinced you care about these same things. (Read more)

Here is what we are asking you to do to make a smaller exposure footprint:

  1. If you have any symptoms of a cold or flu (coughing, fever, difficulty breathing, running nose, etc), please reschedule your appointment for at least one month from now.
  2. Try not to touch any surfaces in the office you do not have to touch.
  3. If you are trying on glasses, DO NOT put the frames back on the shelf. Rather, we will collect them from you for proper cleaning before they are returned to the shelves.
  4. If you are ordering contact lenses, a year supply (and some 6 month supplies) order can be direct shipped to your home at no cost. Please take advantage of this so you don’t have to come into the office more than necessary.
  5. If you do need to come into the office for an adjustment, please call the office at 727-725-5558 when you arrive in your vehicle. We will let you know if there is a wait and will put you on a list so we can call or text you to come therefore minimizing the time you are in the enclosed space of our office.
  6. Please come to your appointment with the least number of people possible to reduce exposure to them and to others at the office.
  7. If you have any loved ones that have been exposed to the virus or certainly if they have symptoms of a respiratory illness, please wear a mask in case you are an asymptomatic carrier, or if possible, wait at least 4 weeks before coming in for non-essential care.

In an effort to protect you, here is what we are doing to help lower your risk:

  1. All surfaces in the office will be cleaned several times per day with antiviral/antibacterial cleaner. Surfaces in the exam room will be cleaned thoroughly in between each patient.
  2. No sick or symptomatic staff will be permitted to work while sick with a known viral respiratory infection or symptoms, or while directly caring for a sick relative/friend.
  3. For your safety, payments can be done ahead of time over the phone if you call ahead. This will decrease the amount of time you are in the store and your exposure risk in our enclosed space.
  4. No glasses frames other patients try on will be put back on display until the frames are cleaned with an antiviral cleanser.
  5. We are actively asking patients to reschedule for 4 weeks later if they have any symptoms themselves or in their family/ social network.
  6. We are giving options for patients to acquire goods by mail rather than coming into the store.
  7. We altering our schedule to decrease the number of patients that might be in the office at the same time to maximize social distancing.
  8. We are practicing frequent hand washing at our office to protect you and each other.
  9. We will ask patients to reschedule if they present to our clinic with a cough or other COVID-19 symptoms.

Thank you for your patience and understanding during this stressful and trying time. Let us all work together to lower risk of the spread so that less people die and less people have permanent side effects from COVID-19. Each of us can do our part. May God bless each of you and keep you well. Thank you for your understanding and care for your fellow humans.

Dr. Christopher K. Keats, OD