SPECIAL REPORT—Children are born into the world assuming their visual perception of it is as others see it. Parents are likewise susceptible to believe that their child’s vision is normal, especially when no initial perceivable eye defect is noticed. The child is learning to walk and talk, expressing their individuality as they grow and parents are ever so eager to watch their children accomplish the fundamental goals up through their toddler years.

In infants, an obvious deviating eye—call Strabismus—can signal a vision problem that should be addressed right away. However, sometimes an eye takes on a weaker viewpoint than an emerging dominant eye. This condition, call Amblyopia, means that the weaker eye may not focus in unison with the dominant eye and may be developing distortion in vision. If the eyes are not aligned properly for binocular vision, double vision may ensue and in the developing brain of a child, the images may gradually become ignored by the brain from the weaker eye leading to blindness.

Even among the most involved parents, Amblyopia leave children with gradual and inconspicuous loss of sight. Left untreated, it can lead to permanent vision loss and a lack of proper depth perception in their vision field for the remainder of their lives.

Amblyopia is estimated to affect, as much as 3% of the general population and can go virtually undetected when the physical symptoms are subtle. As a child with amblyopia grows, they may become more near-sighted in one eye than the other, forcing the other eye to overcompensate.

Affected children may not be able to convey their inability to see in the toddler years since they often assume that their vision is normal. Subtle clues, however, may reveal the symptoms parents should be observing. When a child begins closing one eye to look at a book or if they have begun to read and is having trouble following the lines of a paragraph, these can be possible clues to have a thorough eye exam. The child may become frustrated easier when learning to read and parents may unknowingly accept this as a difficulty in learning to read rather than a vision problem.  Some kids may begin to squint at distant objects or have trouble recognizing familiar faces at an acceptable distance. The older toddler may describe squiggly objects, which can be “floaters” that are often a symptom described by adults with nearsightedness as the fluid in the eye separates and enters field of vision. 

The most important advice for parents is to have your children’s eyes checked by a pediatrician, but do not always assume that even professional health providers will catch a slight variation in your child’s vision. Infants and small toddlers with a slight deviating eye may not be around a doctor long enough to display the tendency of developing amblyopia.

One way parents can check is to sit in front of the child and watch them eat. Pay attention to their eye movements and each eye’s ability to focus on a spoon, fork or a piece of fruit that they grasp and bring to their mouth. If one eye seems to move erratically or reacts slower than the other eye, the child may be at risk of amblyopia.

However, amblyopia is almost always a treatable condition in children and will often be more easily correctable at an early age. While surgery may be in order for some cases in which the eyes are poorly aligned, in most situations a pediatric ophthalmologist simply will prescribe eyeglasses for an affected child and a daily regiment of “patching.” 

“Patching” is when the child’s parents or caregiver places a eye patch over the eye itself or slides one over the eyeglasses, effectively blocking out the dominant or ‘good’ eye and forcing the weaker eye to respond on its own. The patch is usually worn for a few hours each day and as the child gets older, the daily requirement of “patching” is reduced by a couple of hours.  The child while wearing the patch, performs regular daily activities and eye exercises can be simple things like reading with your child with the patch in place or even playing video games since the action forces the weaker eye to stay focused on objects. Most children will prefer to patch privately at home. 

As simple as it may seem, this treatment has been the most successful method for decades and while every child is different and each diagnosis specific, most children recover significantly from this condition and go on to live productively with no or little adverse vision problems.

Left untreated, amblyopia can often lead to the brain essentially “rewiring” itself to ignore vision completely from the affected eye during childhood into adolescents and thus can lead to permanent vision loss that cannot be recovered.