What is Lazy Eye?
Lazy eye or its medical name, amblyopia, is derived from the words 'ambly' and 'ops' and means 'dull eye'. Unilateral or bilateral, best-corrected visual acuity is low due to lack of shaped vision and/or abnormal binocular interaction, without any organic (structural) disorder in the eye or the posterior visual pathways.
Studies show that the frequency of amblyopia is 1%. It was determined to be around .6-3.6.
Causes / classification of amblyopia:
1. Strabismus Amblyopia: It is the loss of vision seen in the squinted eye in children with squint. It occurs most frequently in cases of constant inward slippage. The chance of developing amblyopia is much less in cases of strabismus in the up-down axis.
2. Refractive Amblyopia
a) Anisometropic amblyopia (different refractive errors in the two eyes), where the difference in number between both eyes is over 1.5-2 diopters, amblyopia can be mentioned. Hyperopia and asthymatism. Amblyopia development is more common in refractive errors than in myopia. In myopia, this value is above 3 diopters.
b) Ametropic amlyopia (presence of equally high refractive error in both eyes), for example, presence of size 7 hyperopia or size 8 myopia in both eyes
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3. Deprivation amblyopia (lack of visual stimulus), drooping eyelid (ptosis) that prevents the retinal stimulus from going, opacities of the transparent layer called cornea, cataracts, etc., lens problems, retinal problems.
4. Combined amblyopia, the presence of one or more of these factors
As a result of these factors, the image is not formed clearly on the retina, resulting in amblyopia in infancy and childhood, when vision develops rapidly. Preventing amblyopia and ensuring binocular vision is of critical importance, especially in the first two years when the neural system is still flexible.
50% anisometropia is the cause of amblyopia, Strabismus was shown in 19%, combined in 27%, and deprivation in 4%. While the cause is more strabismus in preschool children, anisometropic amblyopia is more common in the school age.
Diagnosis:
Although no organic pathology is detected in a complete ophthalmological examination. However, in cases where vision cannot be increased, amblyopia is diagnosed.
Since it usually does not cause any symptoms, it can only be detected in scans.
Since amblyopia treatment is more successful at early ages, scans should be performed earlier. It needs to be implemented widely and at an early age. For this reason, screenings should be performed at 3-6 months, 3 and 5 years after birth, and suspicious cases should be evaluated by ophthalmologists.
In addition, parents should be diagnosed with premature birth, strabismus, presence of preferential gaze, tremor in the eyes, watching television closely, abnormal head position. They should consult an ophthalmologist in doubtful cases such as the presence of eye position, significant eye problems and amblyopia in the family, absence of red reflex, severe drooping of the eyelid, presence of white eyes.
Treatment:
Treatment:
strong>In the treatment of amblyopia, intervention aimed at the cause is essential. In order to prevent the development of strabismus amblyopia, patients should be scheduled for strabismus treatment/surgery at the earliest and at the right time. Deprivation amblyopia occurs more quickly than other types, and these conditions should be treated with appropriate methods. For example, cataracts of infancy should be operated on as soon as possible, severe ptosis should be operated on at an early stage, etc.
Often, the causative agent is advanced 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.
Approximately 16-20 weeks after the correction of the refractive error. If the mblyopia still has not improved sufficiently, the child is usually started on closure treatment. In this treatment, the 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 closure per day in deep amblyopia and 2 hours of closure in moderate amblyopia are sufficient in most cases. Working with nearby targets during closure treatment increases the success of the treatment. Although it is not known until what age the closure treatment is effective, children respond positively to the treatment until the age of 12, and between the ages of 13-17, they can benefit only if no treatment has been performed before.
To prevent skin allergy during the closure treatment. Non-allergic patches should be used. Coverings made through glasses do not provide the desired success because children can easily cheat with their good eyes. In addition, recently developed digital smart glasses can also be used for this purpose.
Occlusion treatment can create significant psychological pressure, especially in children who have gained their social identity. In this case, closure treatment can be continued outside school hours. To increase the effect of the closure treatment, the child should be encouraged to engage in reading, painting or computer games. is. Cooperation between the physician, the family and the child is very important to ensure compliance with the child's closure treatment.
Covering is the most effective and rapid method of treating amblyopia. The biggest problem in closure treatment is the compliance of the patient and his family. Close activity during closure increases the effect of the treatment. Children with adequate vision easily adopt computer games during occlusion.
As an alternative to occlusion treatment, it may be possible to prevent accommodation of the healthy eye, i.e., from near vision (penelization), by pharmacological or optical methods. 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 closure treatment in shallow amblyopia. Although pharmacological penalization provides a later recovery than closure, it is more easily accepted by families and children due to its ease of application.
Even if full vision is achieved in both eyes as a result of amblyopia treatment, amblyopia may recur after treatment is discontinued. For this reason, amblyopic children should be followed until approximately 10-12 years of age and receive maintenance treatment if necessary.
In addition, in the treatment of adult amblyopic patients, visual acuity increases with computer-aided software applied every day for approximately 40-50 sessions, which provide vision stimulation called neurovision.
Again, there are different treatment alternatives such as contact lens applications, PRK-Lasik or intraocular lens surgery applications in order to eliminate high anisometropic refractive errors in selected patients in the appropriate age group.
Acupuncture. It has been shown that treatment is at least as effective as occlusion treatment in cases with refractive and/or strabismus amblyopia. Although the mechanism of action of acupuncture is not certain, it is applied to the right points. It is thought to structure the visual cortex. Acupuncture can be effective by increasing cerebral and ocular blood flow, stimulating the release of retinal growth factors, and causing metabolic changes in the central nervous system.
Low-dose laser treatment applied to the macula has been shown to increase visual acuity in cases with adolescent and adult amblyopia.
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Video-games and stimulation with blue/red light are also tried and tested treatment methods in the treatment of amblyopia.
Prognosis:
The most important factor affecting the success of amblyopia treatment. Factors include the patient's age and visual acuity at the beginning of treatment. The smaller the case, the better results are achieved in a shorter time. The lower the visual acuity at the time of diagnosis, the more unsuccessful the outcome and the longer treatment is required.
In addition, in amblyopic children, the use of glasses and eyeglasses causes the child to feel different from others and a decrease in self-esteem. These also affect the patient's compliance with the treatment.
May the light of your eyes never go out! Stay happy, peaceful and healthy.
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