Amblyopia

Amblyopia is loss of vision in one or both eyes because of strabismus, anisometropia (different defects in the two eyes), ametropia (refraction error) or deprivation (lack of visual stimulus). The combination of one or more of the factors listed above results in the absence of a clear image on the retina and this results in amblyopia in infancy and childhood. Preventing amblyopia and maintaining binocular vision is of critical importance, especially in the first two years during which the neural system is yet flexible. The earlier amblyopia treatment is started, the better results can be achieved.

The treatment of amblyopia requires the treatment of the underlying, problem. Conditions such as ptosis and cataracts that prevent vision and cause deprivation should be treated appropriately. The most common cause of amblyopia is refractive errors, which must be corrected with appropriate glasses or contact lenses. These basic approaches can correct amblyopia in a significant proportion of patients without the need for further intervention.

If the amblyopia has not improved sufficiently after approximately 6 months following the correction of the refractive error, patching treatment is usually initiated for the child. In this treatment, the helathy eye is closed at the eyebrow and cheek level with an adhesive so that there is no visual stimulation to the healthy eye. Closing time varies between 20 minutes and a full day, and the ideal method is determined by the ophthalmologist depending on the depth of amblyopia and the age of the patient. Although long-term closure treatment provides faster recovery than short-term closure treatment, the final success is the same. Recent multicenter studies have shown that in the 3-7 age group, 6 hours of patching per day in deep amblyopia and 2 hours of patching in moderate amblyopia are sufficient in most cases. Although it is not known at what age occlusion treatment is effective, children respond positively to treatment up to the age of 12, and between the ages of 13 and 17, they can benefit only if no treatment has been performed before.

As an alternative to occlusion treatment, it may be possible to prevent accommodation of the healthy eye by pharmacological or optical methods. For this purpose, 1 drop of 1% atropine is instilled into the well-seeing eye every day or 2-3 days a week in the morning. While the patient's refractive error is best corrected in the amblyopic eye, optical penalization can also be added with less correction in the healthy eye. These treatments can provide equivalent success to occlusion treatment in shallow amblyopia (vision better than 0.2). Although atropine penalization provides a later recovery than patching, it is more easily accepted by families and children due to its ease of application.

Even if normal visual acuity is achieved in both eyes as a result of amblyopia treatment, amblyopia may recur once treatment is stopped. Therefore, amblyopic children should be followed until approximately 10-12 years of age and receive maintenance treatment if necessary.