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Amblyopia is a condition of low vision in one or both eyes, popularly known as lazy eye Although there is no problem in the eyeball or visual pathways, there is a low visual acuity.

It is seen with a very high frequency of 2-3% in the population, it is a situation we encounter frequently in our routine ophthalmology outpatient practice in children.

However, it is a very important public health problem because it can be detected by eye examination and if it is diagnosed early, it is a reversible and mostly curable condition.

What are the causes of amblyopia?
The most common reasons are high refractive errors (high spectacle numbers-especially high hyperopia and astigmatism) or a difference between the spectacle sizes in the two eyes. In this case, the eye with a high number is neglected by the vision centers and the development of laziness is observed.

In the case of strabismus (crossing in the eye), the visual message from the sliding eye is neglected because it cannot effectively stimulate the visual center, and laziness develops in the crossing eye.

Congenital cataracts (congenital cataracts) and droopy eyelids (ptosis) are other causes of amblyopia. In these cases, there is the development of laziness due to deprivation (decrease in light entering the eye).

What are the symptoms of amblyopia?

When amblyopia is unilateral, it usually does not give any symptoms and is detected incidentally during examination. Since the intact eye takes over all the visual function, the child will not suffer from visual distress and will not notice lifetime laziness unless eye scanning is performed (at this point, the importance of eye scanning becomes apparent). Rarely, some patients may also experience situations such as the desire to close the lazy eye, frequent blinking, and turning the head towards the intact eye.

In the presence of an eye disorder; In children, hand-eye coordination disorder, attention deficit-indifference to toys and writing, writing disorder at school-skipping turns or difficulties in reading can be seen. Whether these eye disorders are accompanied by amblyopia should be investigated.

Is there a treatment for amblyopia?

The treatment of amblyopia begins with the correction of the condition that may be the cause of low vision, such as refractive error, strabismus or droopy eyelid. Then, the intact eye is closed with the help of a closure pad and all visual stimuli are given to the lazy eye – that is, closure treatment is started. There is no specific surgical method or a drug approved for the treatment of amblyopia yet.

How is occlusion treatment done?

Depending on whether the lazy eye is mild or advanced, the intact eye is closed within the closing scheme set by the ophthalmologist, and the lazy eye is exposed to close detailed visual stimuli for a few hours a day (painting, solving puzzles, playing tablet games in a controlled manner).
Occlusion treatment is done when the child is awake and in the company of a parent. If the child cannot adapt to the closure pads, special closing glasses with LED screen are also offered to the market for this purpose.

In children who cannot close, the method of blurring can also be applied to the healthy eye by dropping drops that dilate the pupil, but this method is not preferred for a long time.

What is the critical period in eye closure treatment?

Early initiation of treatment and not exceeding the critical period are the most important factors for complete success in the treatment of amblyopia.
The period of the nervous system that can be stimulated and rehabilitated, which is called neuroplasticity, constitutes the critical period in eye closure treatment. The limit age during this period is 10-12 years. In other words, if the occlusion treatment is initiated early and is performed adequately and effectively, laziness can mostly return, but as of the age of 12, the visual improvement response to the occlusion treatment is low. This critical period is therefore important.

Why is amblyopia treated?

Depth perception and three-dimensional vision develop only when both eyes are used equally.
In addition, the quality of life and career choices in advanced professional life, driving license / license status may be affected because lazy eye can cause legal blindness (vision below 20/200 level).

What are the most important issues in diagnosis and treatment of amblyopia?

Early diagnosis (it may be too late for treatment when the child is about to express his / her complaints)
Correct treatment (Effective treatment, not interrupting the closure early in case of success)
The critical period should not be missed. Periodic eye follow-up is of great importance. (Children in the first 6 months, 2-3 years old, preschool eye examination is recommended)
If there is an eye disease that may be inherited in the family or if the child has a history of prematurity (premature birth), eye examination may be required more frequently than periodic follow-ups.