Lazy Eye Getting Vision Back on Track
LAZY EYE Getting Vision Back on Track
Lately you've noticed that your child's one eye has been straying, looking off to the side while the other eye remains straight. In a newborn, it's common to see the eyes wander. But as a child gets older, his eyes should start focusing and work together--certainly before four months of age. So what's going on here?
A child with an eye that wanders may have amblyopia, or ''lazy eye,'' a vision problem that may affect as many as 3 out of every 100 people, says Robert D. Gross, M.D., clinical assistant professor of pediatric ophthalmology at the University of Texas Southwestern Medical School in Dallas and a pediatric ophthalmologist at the Cook--Fort Worth Children's Medical Center in Fort Worth. While you may be concerned about what your child looks like when his eye drifts, there's much more to it than that. An amblyopic eye is actually a weak eye that has not developed normal vision, says Dr. Gross.
Amblyopia must be diagnosed by an eye doctor. Experts say early treatment by an eye specialist is critical.
To treat amblyopia, eye doctors often use a method called occlusion. By wearing a patch over the strong eye for a certain amount of time each day, the child learns to rely more on the weak eye. ''The earlier you patch, the better,'' says Dr. Gross. ''Parents may be unhappy patching a child at age two, but it may be more challenging to get the child to comply at age six. And besides, the older the child becomes, the harder it is to make a positive change in visual acuity.''
Patching must be done under a doctor's supervision, and the instructions need to be followed to the letter. If your doctor recommends patching, here's how to make it easier for you and your child.
Help your child see the light. '' Wearing a patch isn't much fun, but you can encourage your child by actively showing him why it's necessary,'' says Robert B. Sanet, O.D., a developmental optometrist and director of the San Diego Center for Vision Care in Lemon Grove, California, and associate professor at Southern California College of Optometry in Fullerton. ''If your child is old enough to understand, cover his straight eye with your hand and ask him how it feels to see with the other eye. Explain that the eye is weak and that patching will make it as strong as the other eye.'' child is old enough to understand, cover his straight eye with your hand and ask him how it feels to see with the other eye. Explain that the eye is weak and that patching will make it as strong as the other eye.''
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| When to See the Doctor If your child has a lazy eye, see an eye care specialist as soon as possible. ''The earlier you get care, the less chance the problem has to become established,'' says Sherwin Isenberg, M.D., professor and vice chairman of the Department of Ophthalmology at the University of California, Los Angeles, UCLA School of Medicine and the Jules Stein Eye Institute. ''Even when there are no apparent problems, every child should have a complete eye exam between the ages of three and four,'' advises Kathleen Mahon, M.D., a pediatric ophthalmologist, clinical professor of pediatrics and surgery at the University of Nevada School of Medicine and director of the Mahon Eye Center in Las Vegas. ''And if there is a family history of either amblyopia or the contributing factor of strabismus (crossed eyes), you should consider seeing a doctor much sooner.'' The eye care specialist may be either an ophthalmologist or an optometrist. Both deal with vision problems like amblyopia, but the two types of specialists sometimes use different approaches. Ophthalmologists are medical doctors who are trained and licensed to provide total eye care--everything from examinations to surgery. Optometrists, on the other hand, are not medical doctors, and their orientation is nonsurgical. But they are trained to examine eyes, diagnose problems and prescribe corrective lenses. Developmental optometrists also advocate a treatment method called vision training, which involves specially prescribed eye exercises. Most medical doctors and optometrists treat amblyopia with patches or special eyeglasses. ''The mainstay is patching, and glasses are used when necessary,'' says Dr. Isenberg. In some cases, when amblyopia is caused by other related eye problems, some medical doctors may advocate surgery after the vision has been improved by patching. ''For children who simply won't wear a patch, special eyedrops are available that will blur the vision in the good eye, forcing the child to use the lazy eye to see,'' says Dr. Mahon. |
Pick a patch time. Mark off a designated time for your child to wear the patch. ''Call it patch time and make it the same time every day,'' says Dr. Gross. ''That way, patching will become routine, and the child will know what to expect. If he needs to wear the patch for three hours a day, then he should get to pick which three hours.''
Try to keep it on the home front. It may help to have patch time be during part of the day when the child is home. ''Encourage him to pick a time period like 3:00 to 6:00 P.M., when he's not at school or day care,'' says Dr. Gross. He'll be less self-conscious, and therefore more willing to wear the patch if he doesn't have to wear it in front of all his classmates, he points out.
Another important reason to patch at home is that you as a parent, can supervise the patching process. ''Do not expect your babysitter or day care to enforce patching in your absence,'' notes Dr. Gross.
Take care to prevent peeking. Only an occlusion patch prescribed by your eye doctor should be used to treat amblyopia, according to Dr. Gross. These patches come in two sizes and have adhesive all around, so the patch can be firmly stuck to the face to prevent peeking. The Junior size is for children up to age five or so. Older children generally use the regular-size patch. It's important to securely fix the patch to the child's face and not to glasses, says Dr. Gross. ''If the patch is attached to glasses, the child will be able to peek around the edges with the good eye, and the weak eye will not be challenged enough,'' he says.
Stick to your guns. Enforce patching to the best of your ability. ''Both parents have to be absolutely committed to the process of patching. No matter what happens, the child has to comply,'' says Dr. Gross. ''Be very consistent and very strict. Never make any exceptions. If you make one exception, that destroys your credibility with the child,'' he says.
Manage misbehavior. Dr. Gross offers three suggestions for dealing with kids who misbehave and refuse to wear their patch as prescribed. First, be consistent with your discipline. ''Treat misbehavior with patching the same way you would treat any other type of misbehavior,'' he says. If you use a ''time-out'' or ''go-to-your-room'' tactic at other times, use it with patching mischief, too.
Second, deduct any time spent in patchless misbehaving from your child's daily patch-time quota. ''That time doesn't count toward patch time, and the child will have to make it up. As soon as he realizes that, the behavior should stop,'' says Dr. Gross.
| Straight Talk about Crossed Eyes Crossed eyes might look funny on a teddy bear, but for a real-life child with this problem, it's nothing to laugh at. ''An inward-turning eye is one of the most common forms of misalignment,'' says Sherwin Isenberg, M.D., professor and vice chairman of the Department of Ophthalmology at the University of California, Los Angeles, UCLA School of Medicine and the Jules Stein Eye Institute. ''If left untreated for too long, the eye never develops full vision potential.'' It's important to seek help early. ''If your child is born with an eye that crosses all the time, see your doctor right away,'' says Dr. Isenberg. If an ophthalmologist determines that surgery is necessary, he will probably recommend that the operation be performed relatively soon, according to Dr. Isenberg. Sometimes, a family photograph can help you detect strabismus (crossed eyes) in a young child, according to Kathleen Mahon, M.D., a pediatric ophthalmologist, clinical professor of pediatrics and surgery at the University of Nevada School of Medicine and director of the Mahon Eye Center in Las Vegas. If you see a photograph of your child in which her eyes appear to be different colors, it may indicate that one eye is slightly crossed. Get it checked, suggests Dr. Mahon. |
Third, if a child takes the patch off for an activity, then that activity should not be allowed. ''If a child takes the patch off when he's watching T V, for example, then don't let him watch T V,'' says Dr. Gross.
Go down for the count. Don't skimp on patch time. ''If a child removes the patch even a little bit before the designated time, have him put it back on. If you're not sure how long it's been off, have him start over,'' says Dr. Gross. ''And if patching is not completed one day, then make up for the lost time by adding time the next day.''
Talk to the teacher about teasing. A patch can make a kid the butt of many a joke. So if patch time must be during the school day, enlist the aid of your child's teacher, says Dr. Sanet. ''The teacher can give a lesson on how we are all different, that there are short people and tall people, fat people and thin. He can make the point that differences, such as wearing glasses or patches, are just differences, and do not make people better or worse than others.''
Alert the school nurse. Send the school nurse a ''patching report card,'' suggests pediatric ophthalmologist Kathleen Mahon, M.D., pediatric ophthalmologist, clinical professor of pediatrics and surgery at the University of Nevada School of Medicine and director of the Mahon Eye Center in Las Vegas. It should explain what the child's vision problem is and note the hours that the child should be patching. ''Ask for the nurse's and the teacher's assistance. It helps to have someone at school who checks on the child,'' she says.
