Detecting Lazy Eye (Amblyopia) in Children

Author: Children's Hospital Boston
Published: 2011/07/08 - Updated: 2024/10/15
Publication Type: Research, Study, Analysis
Peer-Reviewed: Yes
Topic: Blindness and Vision Loss - Publications List

Page Content: Synopsis - Introduction - Main

Synopsis: A simple screening exam with a handheld scanning device may enable pediatricians to identify lazy eye in children as young as two years of age.

Why it matters: This article on lazy eye (amblyopia) provides a comprehensive overview of this common vision disorder. It offers insights into the causes, symptoms, and treatment options for lazy eye, which affects approximately 2-3% of the population. The article's usefulness lies in its clear explanation of how amblyopia develops during childhood and the importance of early detection and intervention. By discussing various treatment approaches, including patching, vision therapy, and surgery, it equips readers with knowledge to make informed decisions about their or their child's eye health. Additionally, the article's exploration of the long-term effects of untreated lazy eye underscores the significance of timely medical attention, making it an insightful read for parents, educators, and healthcare professionals alike - Disabled World (DW).

Introduction

A simple, seconds-long screening exam with a handheld scanning device may enable pediatricians to identify "lazy eye," a loss of vision in a structurally normal eye, in children as young as 2, report ophthalmologists at Children's Hospital Boston, who tested the device in 202 children.

Main Item

Lazy eye or amblyopia, affecting 3 to 5 percent of all children, is the leading cause of vision loss in childhood. But it can be hard to detect in young children, who are the most responsive to treatment, because they cannot reliably communicate what they're seeing or read eye charts.

"The eyes of a child with amblyopia can look perfectly fine, even while one eye is slowly losing vision," says senior author David Hunter, MD, chief of ophthalmology at Children's Hospital Boston. "Once a child reaches school age, treatment is less likely to restore useful vision. We'd really like to begin treating them when they're three years old - or younger."

Amblyopia usually results from a misalignment of the eyes (strabismus) or one eye having a weaker focusing power (anisometropia). In both cases, one eye is underused, and vision deteriorates as the brain loses its ability to interpret visual information from that eye. If the problem is detected early, ideally before age 4 or 5, doctors can reverse it by patching the stronger eye or blurring it with eye-drops, forcing the child to use the weaker eye.

Clinical testing of a prototype of the device, known as the Pediatric Vision Scanner, is described in the July 7 issue of the journal Investigative Ophthalmology and Visual Science. As children look at a blinking red light, a low-power laser scans their eyes to measure their alignment (known as binocularity), taking five readings over 2.5 seconds.

Hunter and colleagues tried out the scanner in 154 patients at Children's ophthalmology clinic and 48 children with normal vision, aged 2 to 18. Children with readily identifiable strabismus, other eye disease or developmental delay were excluded.

A binocularity score below 60 percent (fewer than three focusing successes in five attempts) was considered a "refer," indicating a need for further examination. Among 2- to 6-year-old children, binocularity scores averaged 9 percent for those with amblyopia and 8 percent for those with strabismus, versus 89 percent in the control group. The scanner could detect amblyopia even in the absence of measurable strabismus, and documented improved binocularity in these children after treatment.

"We designed the device to detect strabismus, but the fact that the device could detect any form of amblyopia was completely unexpected - and a key advance for making more accurate referrals," says Hunter, also a professor of ophthalmology at Harvard Medical School.

Overall, the scanner had an overall sensitivity and specificity of 96 percent for detecting amblyopia or strabismus as compared with gold-standard ophthalmologic tests. Hunter hopes the device will be adopted into general pediatric practice and used to screen toddlers and preschoolers for amblyopia during annual well-child visits. Eye exams done just before entry to school, mandated in some states, come too late to treat amblyopia most effectively, he says.

"This technology has the potential to give pediatricians the tool they need to quickly and easily identify those kids most in need of a specialist eye exam as soon as they develop a problem," Hunter says. "As a result, we expect that health insurers and government agencies will embrace this test, which should reduce the cost of care while at the same time improving quality and efficiency, potentially saving vision in hundreds of thousands of children."

The scanner is the result of 20 years of research funding from a variety of agencies. A lighter, more user-friendly prototype of the device is currently undergoing clinical testing at several independent centers.

Research fellow Sjoukje Loudon, MD, was first author on the paper, along with co-authors Caitlin Rook, CO, Deborah Nassif, PhD, and Nadya Piskun, PhD. The device was developed with the help of David L. Guyton, MD, and Boris I. Gramatikov, PhD, of Johns Hopkins University, and Robert Winsor, MSEE and Knute Ray, BS, formerly of the Space Telescope Science Institute.

Related Information

• Revolutionary Vision Therapy: AmblyoPlay Unveils Peripheral Sight Enhancer: AmblyoPlay launches Active Peripheral Stimulation (APS) intended to advance treatment of peripheral vision deficiencies and improve effectiveness of home-based vision therapy.
• Lazy Eye: Is Photoscreening the Best Way to Catch Amblyopia: Photoscreening for lazy eye (Amblyopia) was used as earlier studies indicated problems with using eye charts to screen children younger than age 3 and children with disabilities.
• Action Video Games Improve Vision: Video games that involve high levels of action such as first person-shooter games increase a players vision.
• Lazy Eye (Amblyopia): Causes and Treatment: Information on Amblyopia, or lazy eye, an eye condition noted by reduced vision not correctable by glasses or contact lenses.

Attribution/Source(s): This peer reviewed publication was selected for publishing by the editors of Disabled World (DW) due to its relevance to the disability community. Originally authored by Children's Hospital Boston and published on 2011/07/08, this content may have been edited for style, clarity, or brevity. For further details or clarifications, Children's Hospital Boston can be contacted at childrenshospital.org NOTE: Disabled World does not provide any warranties or endorsements related to this article.