Zara wrote:
Hi my name is Zara, I took my 8yrs old to the optometrist and he told me she has a Amblyopia, he gave her prescription eyeglasses for six months, he said after six months if no improvement he’ll patch the good eye. I just want to know which one is first The patching or the prescription glasses. Thank you

ANSWER

Hello Zara,
Typically the prescription glasses are tried first.  If there is no improvement, or improvement is very slow, patching the “good” eye is begun.  This forces the “poorer” eye to work harder.  Please remind your daughter that she must wear her glasses during all waking hours.  Also make sure that she is not cheating by peaking out from around the lenses, or around the patch.  It is very important to follow your optometrist’s instructions because the older your daughter gets, the more difficult amblyopia is to treat.
Good luck to you!
Dr. Donati

Sharon H. wrote:
Daughter is 3 1/2 yrs old and was just seen by an optometrist who advised me that she has farsighted astigmatism in her left eye.  Her right eye is fine. Her Rx reads +200 (sphere), -200 (cylinder), 180 (axis), P.D. 52.
I was also advised that she needs to wear a patch on her right eye for 1 hour everyday.
Are the glasses a temporary measure (i.e. will this improve over time as her eyes mature)? How exactly does the patch therapy improve farsightedness or astigmatism?  I’ve read that patch therapy is often used for lazy eye so I’m confused as to whether this is also an issue for her or not.
Is it sufficient for a patch to just cover the glass lens or does it have to completely occlude the eye?  I foresee issues with compliance in wearing the patch and the glasses.  Any tips?

ANSWER

Dear Sharon
Whenever there is a significant difference in the prescription between the two eyes, there is a distinct possibility that the eye with the greater prescription will have some degree of amblyopia, or lazy eye. The glasses will compensate for your daughter’s far sighted astigmatism and give her clear vision in both eyes. The glasses will not “correct” the astigmatism, but will give clear vision despite the astigmatism. I suspect that your optometrist has detected a small degree of difference in the “best corrected visual acuity” between the two eyes – hence, your daughter may have a small degree of amblyopia. Although the difference between your daughter’s eyes is significant, they are not so different from each other that your daughter is likely to have serious amblyopia. However, temporarily wearing a patch on the good eye will force the brain to use the eye with the poorer vision and this usually improves the vision in the poorer eye more quickly than just using the glasses alone. Wearing the patch does not improve farsightedness or astigmatism.
Based on your daughter’s prescription, it would be reasonable to try putting the patch on just the lens for starters. If you see that she is peeking around the covered lens, then complete patching of the eye would be advisable. In cases of mild amblyopia, a patch on the lens is sometimes better tolerated than using  a complete eye patch.
While I am glad to offer my cyberspace advice, it seems to me that your questions would best be answered by the optometrist who examined your daughter. He or she would have first hand knowledge about how well your daughter is seeing with her weaker eye, and should be able to provide you with clear answers  to your very valid questions about your daughter’s treatment plan.
Hope this is helpful.
Dr. Smit

Marsha wrote:
I am 43 and have amblyopia. Despite patching & surgery as a child my sight in my “bad” eye is 20/200. I find when I read I get eye strain in my bad eye. My good eye is not quite ready for reading glasses - I find I am tending to look under my glasses to read but 1.0 reading glasses are too strong.

What can I do for the eye strain? Would patching the bad eye help when I’m reading?

Thanks,
Marsha

ANSWER

Dear Marsha
When a person enters their “forties” they usually become aware that they are losing their ability to focus their eyes for near tasks such as reading. Based on the fact that you look under your glasses to read it would appear that you are slightly myopic (nearsighted). If you are in fact nearsighted, as I assume you are, you do not need to focus as strenuously to see things up close when you take off your glasses, or look under them as you are doing. Wearing a pair of +1.00 readers makes your eyes focus even less, and coupled with the benefits of taking off your distance glasses, this may result in an over-correction for your close vision. You might try reading without your glasses and no reading glasses to see if that makes you more comfortable. If it does not, you should consult your optometrist for a thorough assessment to determine what prescription would be most suitable for your needs. I would not recommend patching the bad eye.

Hope this helps.
Dr. Henry Smit

Iva wrote:
Hello
My name is Iva and I’m writing to you because I’m concerned about my brother’s lazy eye. He is only 17. By lazy eye, I mean that his eye looks like Paris Hilton eye.
It has only been 2 years that he’s been wearing glasses. When we went to the doctor he told us that the number on the other eye was rising (from 0.3 to 0.5). He prescribed two medicines, Betoptic and another one. He told us that when my brother is 21 years old, he can have surgery. His vision on the right eye (the lazy one) now with the glasses is only 60%.
Please, I have so many questions…
Can the surgery wait until he is 21 years old?
What can we do now to protect the other eye?
Thank you for your time!

ANSWER

Iva,

It sounds like a few different issues.  The lazy eye, which you say looks like a Paris Hilton eye, I think, means that his eye is turning out.  This is generally caused by a problem with the eye muscles and can sometimes develop if the vision in that eye is significantly decreased.  The fact that the eye is turning out is mainly a cosmetic issue. Having surgery to straighten the eye muscles, will unfortunately not improve the vision in that eye.  Therefore waiting to have surgery to straighten the eye will not cause any further damage.  By the other information you have given me it sounds like he has glaucoma.  The numbers you gave (0.3-0.5) would be used to describe the optic nerves in the back of the eye.  This number represents the shape of the optic nerve. I am a little confused, but I think you mean that this number is changing in his good eye?  The medication they have prescribed is an anti-glaucoma medication. This will decrease the pressure inside the eye, which should stop the optic nerve numbers from changing. This will help to protect the good eye.  I understand that it can be very worrisome when someone in your family has serious eye problems.  Hopefully my answers have helped somewhat.

Dr. Doman

Tyler wrote:
Hi I’m 16 and I have a lazy right eye my eye doctor told me there’s nothing to do but I have been reading things on the internet that say different. I don’t really care that I see better with my lazy eye I just want it to look straight. What kind of surgery would I need? My contacts aren’t really helping me right now. I would really just like to find out a solution to my problem.
Thank you

ANSWER

Hello Tyler,
First, I should tell you that “lazy eye” is a very broad term that can mean a few things.  I’m not sure exactly which type you suffer from, but based on your concerns I will assume that one of your eyes is not straight and that same eye does not see as well as the other “good” eye.  If that is the case, than your optometrist is correct in saying that there is not much that can be done to improve the vision of the affected eye.  However, if your concern is mainly cosmetic, you may be able to have the eye surgically straightened.  Ask your optometrist for a referral to a surgeon who specializes in strabismus correction.  He/she may be able to help.
Dr. Donati

Sarah wrote:
I took my 3 year old son to the ophthalmologist today because I was concerned about his squinting. After a two hour visit, it turns out the squinting just is a mannerism and his eyesight is fine. He does, however, have minor astigmatism in his left eye, more severe in his right. The doctor wants him in glasses.
I’m feeling as though we’re fixing a problem that doesn’t exist—one that we wouldn’t have known about if I hadn’t been concerned about a behaviour that turns out to be nothing.
What are your thoughts? Would it be terrible not to get the glasses?
Sarah

ANSWER

Dear Sarah:
I think that if, after a two hour examination of your son, your ophthalmologist recommends that he wear glasses, I would take the doctor’s advice. Astigmatism is a real problem and if there is a greater amount in one eye than the other, it is possible that it may contribute to the development of ambylopia (lazy eye) in the weaker eye. Amblyopia responds to treatment best if treatment is started as early as possible, so getting the glasses as soon as possible would be the preferred course of action. As far as the squinting is concerned, even though it may be a mannerism, your son’s astigmatism may be a contributing factor.
Hope this is helpful.
Dr. Smit

Sophie wrote:
 
I am 74 years of age and I have been told I have one lazy eye because I did not wear a patch as a child. I had a cataract removed on that eye which I see no different with. I may need to have one done on the good eye, I am nervous.  Should I go for another opinion?  Who is best qualified, an optometrist or ophthalmologist?
 
Thank you so much.

ANSWER

A lazy eye (also called an Amblyopic eye) develops in children who have one eye that sees very differently than the other.  The brain ignores the one eye and it becomes lazy.  That really means that no matter what we do, it is not possible to make that eye see better.  This is what has happened after cataract surgery.  The other eye (if it is healthy inside) should see much better following cataract surgery.  Now that the surgeon has done your lazy eye, he (or she) knows if there are any special considerations to take into account when doing surgery on your good eye. 

As to the second opinion, i would suggest that you could see either, but I would suggest that you have the same surgeon do your other eye, for the reason I stated above.

Dr. Joan Hansen, Optometrist for CAO

David wrote:
I have noticed in my 3 year old daughter recently that her right eye tends to slightly shift to the direction towards her nose, especially far distances, but not limited to that. Her mother and I are obviously concerned and hope that it isn’t a serious issue or lazy eye. She loves to read books, do puzzles and of course watch movies. Reading some of the older posts, it seems normal, but is it best to get her into see a paediatric eye doctor? Is this common and can you give any guidance or an answer based on your professional opinion?

Thanks.

ANSWER

David,
This condition has to be addressed properly and your daughter should be examined by an optometrist or an ophthalmologist as soon as it is possible. At age 3, a deviation of 1 eye, at certain distance and under certain circumstances, is mostly related to a huge effort of this eye to see properly. The eye sees but has to compensate for a refractive error called hyperopia. If not measured and corrected, this eye will develop strabismus over time.
The appropriate examination should be done under cycloplegics drops. That means that the doctor (optometrist or ophthalmologist) will put a drop on the eye that will allow him to measure the refractive error without the effect of the natural compensation of the eye. This is the only way to make sure that everything is OK. Depending on the results, a pair of glasses, stronger on the right side in your daughter’s case, could be prescribed. This will prevent the eye from deviation and developing strabismus and/or lazy eye.
For most of the patients, this condition fades over time and it is not rare that patients can be free of glasses by the age of 10-12. For some of them, however, the hyperopia remains and the condition has to be corrected by optical means. By the age of 8-10, it is appropriate to consider correction in contact lenses especially if only one eye is involved.
Please be sure to consult your optometrist sooner rather than later and to tell him about the symptoms you witnessed and described here.

Good luck,
Langis Michaud

Amy wrote:

Hi,

I underwent 2 eye surgeries at the age of 2 and 3 for “lazy eye”. Because of the scar tissue in my eyes, I am not able to wear contact lenses. I wore bifocals as a young child, and no glasses in my early teen years until I got my driver’s license. I am currently 32 and my vision has been decreasing dramatically for about the last 5 years. (Therefore, I am obviously not a candidate for Lasik). I used to be able to function normally and just needed my glasses for driving but I now can’t even see my alarm clock. I don’t have too many problems up close, though I do have some blurriness in my left eye when reading the newspaper. (My left eye was always weaker, and I am told I could have gone blind had it not been for my 2 childhood surgeries).

My surgeries, according to my doctor who is now retired, were the most successful of any patient he ever had. My new eye doctor has not been able to give me any answers as to why my long-distance eyesight is now decreasing so much, but he tells me I don’t need to worry about disease (even though they have not done any kind of testing other than the basics of an eye exam). I am very frustrated as I used to be a -1.25 and am now almost a -5.00. My astigmatism has also gotten worse. My doctor said he has never seen this before and because I don’t have any kind of vision insurance coverage I’m not sure what to do or if it would be worth my while to see someone else.

I’m wondering if there are tests that they should be doing instead of just shrugging their shoulders. I just got new lenses 6 months ago and already can’t see out of them (especially driving at night). When I get new lenses I have a really, really difficult time adjusting to them. It is weeks of headaches, dizziness and eyestrain. I’m at a loss and it’s very hard on me emotionally, not to mention financially. Do you have any advice or is there some kind of specialist I should see?

ANSWER

Dear Amy,
It is somewhat unusual for a patient to rapidly become more nearsighted around the age of thirty, although I have seen it happen in a few of my patients who spend excessive amounts of time doing very close work. There are several reasons why your vision may be worsening quickly. Usually nearsightedness (myopia) is associated with a lengthening of the eyeball. This is why myopia usually starts during the growing years. In some individuals, as the eye grows to it full adult size, the length of the eye becomes too long relative to the curvature of the cornea resulting in poor vision at distance – myopia. Since your problem started in your adult years, it is less likely that your eyeball has had a growth spurt, although this remains a possibility. Changes in the curvature or density of the crystalline lens inside your eye can also contribute to the development of myopia. However, it is more probable that your change in vision is being caused by a change in the curvature (topography) of your cornea. Your cornea is the main light bending surface in your eye, and changes there can have a dramatic effect on your vision. There are certain degenerative conditions of the cornea that tend to have their onset around age thirty and further investigation should be done to carefully measure the shape and topography of your cornea. This is done with an instrument called a topographer, which most optometric practices do not have. Your optometrist can, however, arrange for you to have this procedure done elsewhere, often at a laser vision correction center. I would advise you to consult your optometrist again and ask to be referred elsewhere to have this procedure carried out. Topography may shed some light on the reason why your vision is changing so rapidly at this age.
I hope this helps.

Dr. Henry Smit

Michelle wrote:

My 6 year old has recently been prescribed Atropine Sulphate 1% eye drops for amblyopia, however, from the little information I can find about it I am unsure if I want to use it on her as I am extremely concerned about its safety in children. I wasn’t given much information from the specialist who prescribed either, except that it could cause blurred vision (thought that was the point of it), flushing and fever.  Also, I’m not sure if it should be used on a child with a heart murmur.  If I’d known prior to the appointment about adverse effects that I’ve read online I would have questioned the doctor more.  Unfortunately, I am unable to contact that doctor about it. Any information would be greatly appreciated.

AMSWER

Hi Michelle,

Thanks for your question.  The main thing is that your daughter’s amblyopia (lazy eye) be treated to prevent permanent vision loss.  There are generally two ways to treat amblyopia.  The more common treatment is patching of the good eye to strengthen the amblyopic eye.  The other treatment is blurring of the stronger eye with eye drops (commonly Atropine) to strengthen the weaker eye.  The disadvantage of patching is that a lot of times compliance is an issue.  It can be hard for parents to get their children to wear the patch for the specified amount of time.  As you have mentioned above the disadvantage of Atropine is that there are potential side effects.  That being said the ocular dosage of Atropine is very small and only a small amount gets absorbed into the body.  Because of this side-effects of the ocular administration are uncommon.  Studies have shown that the treatment of amblyopia with patching or Atropine will give the same result.  However it has also been shown that compliance is higher with Atropine than with patching.  I assume that you must have a follow-up appointment with the specialist?  Can you phone their office to ask these questions? As far as the use of Atropine with a heart murmur it would be best to discuss this with your daughter’s family physician and pharmacist.  I always treat amblyopia with patching and this is consistent with most optometrists.  I educate the parents on the importance of the patching and that it is essential to prevent permanent vision loss, which usually helps to increase compliance.  This is one of those cases where there isn’t necessarily one right answer.

Dr. Carol Doman