Amblyopia - what is it? Amblyopia in children: degrees and treatment

According to the latest statistics, amblyopia was detected in 2% of adults in our country, but among children the situation is somewhat different, as evidenced by frequent visits to eye clinics or specialized medical institutions. According to experts, the vast majority of young parents do not know what amblyopia is in children, and are not aware not only of its symptoms, but also of the possible consequences. Therefore, today's article is dedicated to the answer to this question.

What is amblyopia

This pathology, which is called the "lazy" eye, is characterized by a reversible decrease in vision in one or less often both eyes. This happens due to various functional disorders, such as strabismus, pathologies of the fundus of the eye, and clouding of the lens. Because of this, the transmission and perception of an adequate image is disrupted. As a result, a person sees two completely different pictures instead of one voluminous one, as a result of which the work of one eye begins to be suppressed and deteriorate over time. As you know, if a person has at least one organ that does not work, then it will atrophy over time. Thus, the faster the treatment begins, the more chances there are for a full recovery of the child. But about this in order.

Types of Amblyopia

When asked about amblyopia - what is it, it should be said that this disease can be confused with other pathologies, which also lead to a decrease in visual acuity. Therefore, to avoid such an error, we consider the types of amblyopia.

Distinguish between primary and secondary forms. Primary include:

1. Refractive amblyopia, which appears in children with untimely correction of ametropia. Allocate one-sided, two-sided, symmetric and asymmetric.
2. Dysbinocular amblyopia. As you can already guess, the basis of this pathology is a disorder of binocular vision, which is provoked by strabismus and the lack of timely treatment. As practice shows, such a pathology is more clearly manifested in the eye that mows.
3. Mixed amblyopia, which is expressed both in manifestations of refractive and dysbinocular forms.
4. Hysterical amblyopia. In this case, a decrease in vision occurs with disturbances in the functioning of the central nervous system. The most common cause is psychological trauma.

About secondary amblyopia, one should know that the pathology of the visual organ, which has been successfully eliminated, can serve as the cause of such a disease. But because of this, a decrease in vision could occur.

They include:

1. Obscuration amblyopia, which appeared due to pathology of the visual organ, which prevents the appearance of pictures on the retina. Of the most common manifestations, congenital or acquired cataracts are distinguished. The obscuration form can appear in one or two eyes.
2. Neurogenic amblyopia. The cause may be diseases of the optic nerve. To date, cases of complete cure have been recorded. It should be noted that the treatment of such a pathology begins after surgery.
3. Maculopathic. It develops after transferred diseases of the central and paracentral zones of the retina.
4. Nystagmus amblyopia. It is caused by a decrease in the time interval for the image to stay in the central zone of the retina.
5. Combined amblyopia. Manifested by a combination of the above forms.

Strabismus with Amblyopia

But for all the variety of reasons leading to amblyopia, strabismus prevails among them. As you know, normally the eye muscles move simultaneously, thus ensuring the normal functioning of the organ. But if there is a malfunction in the work of at least one muscle, a problem arises with movement control, that is, strabismus develops, after which amblyopia of the eye occurs. So, we can state the fact that strabismus and amblyopia are two sides of the same coin.

Of the most common causes that lead to muscle weakness, there are:

1. Farsightedness.
2. Disorders in the psyche.
3. Eye damage.

Symptomatology

The most common symptoms of this disease include:

1. Decreased visual acuity in one or both eyes.
2. Frequent dizziness associated with poor perception of volumetric objects.
3. Difficulties during training.
4. Deviations of the eye in the opposite direction from the direction of view.

Diagnostics

As mentioned above, the answer to the question of amblyopia - what is it, and this article will be devoted. Therefore, we turn to the story of the diagnosis of this disease. So, in children this is done by different methods.

Visiometry

As a rule, at each age, the child has a kind of visual acuity bar. But the task of the optometrist should be to determine the greatest visual acuity without adjustment and with adjustment. The features of visiometry in children include:

1. Clarification before the start of the examination whether the child is familiar with the pictures that are shown on the table.
2. Conducting a survey with constant praise of the child, if he answers correctly.
3. If a low indicator of visual acuity is detected, it is recommended to repeat the examination after a few days, and you need to start with the eye that showed the worst result.

An important point of the examination is careful monitoring of the child in order to keep him from possible squinting.

Refractometry

It is able to show whether children have amblyopia or not. Such an examination takes place using a refractometer or keratofractometer. An important role in the diagnosis is played by the correct placement of the child behind the device. It should be borne in mind that the primary indicators of the device may slightly differ from the subsequent ones, therefore it is recommended to re-diagnose several times to confirm the diagnosis of eye amblyopia.

Degrees

To date, doctors distinguish the following degrees of amblyopia:

1. Very low degree - visual acuity of 0.8–0.9.
2. Low - 0.5-0.7.
3. Amblyopia of an average degree - 0.3–0.4.
4. High - 0.05–0.2.
5. Very high - visual acuity below 0.05.

High-grade amblyopia is usually accompanied by impaired binocular vision.

Amblyopia in children: treatment

With a diagnosis of amblyopia, treatment can be either conservative or surgical.

Important! The degree of visual acuity after surgery is affected by the degree of amblyopia.

So what to do if amblyopia is diagnosed in children? Treatment usually begins with occlusion, optical correction, penalization, and visual therapy.

Optical correction

When diagnosing a child with amblyopia, which is accompanied by ametropia, one of the conditions for successful treatment is the appointment of constant wearing of glasses or lenses. Particular attention in the presence of high degrees of ametropia should be given to the selection of high quality lenses, preferably with an aspherical design, since these lenses have an extremely effective optic zone, which is important in the treatment of amblyopia.

The use of occlusion

The use of occlusion is today the standard in world medicine. Occlusion happens:

1. Direct (when the normally seeing eye closes).
2. Reverse (when the eye closes, in which visual acuity is less).
3. Alternating (alternate eye closure).

By frequency it happens:

1. Permanent.
2. Partial.
3. The minimum.

The principle of operation of this method is to enhance the functionality of the poorly seeing eye by excluding the healthy eye from the work. As practice shows, the effectiveness of this method in children under 6 years of age is significantly lower than in older ones. This is explained by some difficulties related to a greater extent with the psychological factor.

An important element for successful treatment is the correction of eccentric fixation.

But it will be correct to mention some negative aspects, which may entail the method of occlusion. These include:

1. Lowering the level of vision in a healthy eye. This happens, as a rule, due to neglect both by parents and doctors.
2. The development or strengthening of strabismus.
3. Diplopia (double objects).
4. Problems with the skin.
5. Various allergic reactions.

It is especially worth noting that one of the main reasons for the failure in treatment with the occlusion method is the disinterest of the children themselves in the prolonged wearing of the bandage.

Penalization

Penalization is a method of treating this disease, in which artificial anisometropia is created using various combinations of optical correction and the combined (as prescribed by the doctor) use of atropine for the eye, at which the percentage of vision is higher. The principle of action of atropine is to create fuzziness in a healthy eye after it is instilled, as a result of which the work of the eye, which sees worse, is activated. This method, unlike occlusion, is more suitable for children and much more effective.

But do not forget that he also has negative aspects. These include:

1. The appearance of redness on the skin.
2. Irritation in the eye.
3. Frequent headaches.
4. Intensive therapy of vision.

This technique is used for intolerance to occlusion. It combines methods aimed at restoring or improving the fixation and movement of the eyeball, perception in space, accommodation of vision. For this purpose, special devices, for example a synoptophore, can be used. One of the advantages of this technique is considered to be a significant reduction in the treatment period with sufficiently high indicators of visual acuity.

Treatment for amblyopia and strabismus

As mentioned earlier, treatment for amblyopia can only begin after eliminating its causes. And if amblyopia developed against the background of strabismus, then the first thing we do is eliminate it. To date, several treatment options for this pathology are known. These are operational and therapeutic methods:

1. Pleoptics. Treatment consists in increasing the load on the eye that mows. To achieve this effect, both a special laser and PC programs are used.
2. Orthoptics. In this case, synoptic devices and PC programs are used to restore vision and eliminate strabismus.
3. Diploptics. Vision restoration at home.
4. Special exercises are used to improve the work of the muscles of the eye.

It is important to recognize the fact that strabismus will not pass with age, as some mistakenly believe. In addition, if not cured in a timely manner, it can lead to very sad consequences. Remember that the maximum age when strabismus treatment gives the best effect is 25 years.

Home treatment

The insidiousness of this disease lies in the fact that with insufficient zeal during its treatment relapses are possible. Therefore, it is especially important to show persistence to parents, since often a child who is diagnosed with amblyopia does not understand what it means to see well, since his level of vision seems normal to him. Therefore, it is necessary to combine the procedures in medical institutions and the treatment of amblyopia at home. After all, only the joint work of the whole family can bring such a desired and long-awaited result as good eyesight. And a special program for the treatment of amblyopia at home will help with this. Although each program is individually selected by the doctor, there are several exercises that are suitable for everyone.

Exercise lamp

To do this, take a thick black sheet of paper and a light bulb with a capacity of up to 80 V. Next, cut out a circle of paper with a diameter of 8 mm and glue it on the light bulb. After that, the child should close his eye, which he sees better, and for 30 seconds look at the light bulb, and then at a clean white sheet of paper, previously glued to the wall. It is necessary to watch before the image of the light bulb appears on paper. The exercise should be repeated for 1-2 months several times a day.

Text exercise

We close the child with a good seeing eye blindfold. We pick up the pre-prepared text in small print and bring it to the second eye at the maximum permissible distance at which the child can read it. After that, we begin to move the text very slowly until it becomes difficult to read. Repeat this exercise several times.

Exercise with a larger lamp

We choose a lamp with a larger power and a thick black sheet of paper. We cut out a cap with a hole (6 mm in diameter) in the middle and put it on the lamp. After this, the hole is closed with a red film. We put the lamp at a distance of at least 40 cm from the child and turn it on. The child’s task is to look at the lamp for 3 minutes without being distracted by anything, and parents must turn the lamp on and off every 3 seconds.

Using flash

To do this, you need a camera with a flash and a piece of paper on which you can draw images or letters. The procedure is as follows: a flash is brought up to the eye level of the child (at a distance of at least 50 cm) and a series of flashes is performed (up to 10). After each of them, the child should look at a sheet of paper and try to make out what is written there (a sheet of paper should be placed within a meter or two). The recommended number of lessons per day is up to 3 times, the total duration is up to 2 months.

Fine handwork or games where accuracy is necessary proved to be not bad.

Some tips

In order not to have to look for the answer to the question of amblyopia - what is it, you must adhere to the following rules:

1. Perform periodic preventive examinations with an ophthalmologist.
2. If the child reveals even the slightest hint of strabismus, you must at least confirm or refute this diagnosis by completing the necessary studies in an ophthalmic clinic or a specialized medical institution.
3. Do not provoke the development of strabismus by placing toys or bright objects near it.
4. Provide the child with good nutrition and eliminate stressful situations.
5. Constantly engage in his self-development.
6. At the first manifestation of vision problems, consult a specialist immediately.

As practice shows, the prognosis for amblyopia is favorable with timely treatment, but here the following is important:

1. Strict observance and implementation of all recommendations of the attending physician.
2. Type of amblyopia.
3. The location of the eye.
4. Initial visual acuity.
5. Age category of the patient.
6. The method of treatment.

The main thing to remember is that if you set a goal and go towards it, then nothing is impossible in the world. But it should be noted that in the future an untreated patient may face complete loss of vision. Therefore, it is recommended to prevent the development of this disease, to know in advance the answer to the question: "Amblyopia - what is it?"