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Visual maturity is said to be complete by around 8 years of age and any disturbance of vision in one or both eyes before this age can cause lazy eye or amblyopia, which is one of the most important causes of ocular morbidity in children. Generally, it develops from birth till 7 years of life and is reduced vision in one or both eyes due to abnormal visual development and faulty processing of visual connections from the eyes to the brain in the early years of life.

As per the reports, the percentage of amblyopia in Indian children is 5-12 percent while the global percentage is 1-2 percent.

In an interview with HT Lifestyle, Dr Priyanka Singh (MBBS, MS, DNB, FAICO), Consultant and Eye Surgeon at New Delhi's Neytra Eye Centre, shared, “Any factor that hinders the passing of light rays to the eyes and to the brain will cause amblyopia.”

Dr Sowmya R, Consultant, Department of Pediatric Ophthalmology and Strabismus at Bangalore's Sankara Eye Hospital, listed the common causes of amblyopia as:

2. Strabismus or squint in the eye

3. Media opacities in the eye like corneal opacity or cataracts

Elaborating upon the same, Dr Priyanka Singh explained:

1. Misalignment of eyes also known as squint - Imbalance of eyes that leads to inward or outward turning of one or both the eyes.

2. Refractive errors - High refractive errors like increased (+) or (-) power of eyes or significant difference in power of eyes.

3. Cataract - Present since birth or in infants

4. Corneal opacity - Cloudiness of cornea present since birth or in the early years of life.

5. Ptosis of upper eyelids - droopiness of eyelids, present since birth, hindering vision.

Highlighting that these causes may be in one eye or both eyes which when left untreated result in lazy eye, Dr Sowmya R said, “Refractive errors are one of the common causes of lazy eye especially when there is a difference in powers of the two eyes. Children with refractive errors in one eye usually do not have any complaints as they manage comfortably with the other eye and that leads to late recognition and lazy eye to have set in by then.”

She added, “Similarly with squinting or strabismus leading to amblyopia as the vision loss in the strabismic eye is usually masked as child manages with the other normal eye. Further, parents or caregivers consider squint as a sign of luck and don’t get the children for eye check till it leads on to lazy eye.”

Dr Priyanka Singh asserted that careful assessment of eyes is necessary to observe any kind of warning signs that may be:

1) Unable to focus or follow objects from 2 months of age.

2) If the eye turns inwards or outwards

3) Whitish reflex present inside the eye

4) The child frequently bumps on nearby objects while walking

5) Head tilting while watching TV or studying

7) If the child goes very near to the screen to see or keep books very close while reading

In case of any warning signs, an immediate eye examination is necessary for early treatment. In most cases, the disease is not easily noticeable so, routine eye checkup is recommended between age 3-5 years to prevent amblyopia.

As already said, lazy eye is a consequence of refractive errors, squint etc and can be prevented by detecting and treating these causes in time. Dr Sowmya R said, “The most important aspect in this regard is a regular eye check for every child before the age of 5 years. If the child has a droopy eyelid or white lesion on the eye or squint needs an eye examination at the earliest irrespective of the age. The school authorities can insist on eye check-up report on 1st day of school to ensure children have good vision and can be treated on time if problem exists.”

She revealed, “The treatment varies depending on the cause of amblyopia. Lazy eye responds to treatments like patching quickly till 8 to 10 years of age but remains effective till 14 -18 years. Newer therapies like binocular therapy are effective in older children and adults but with limited success. Timing of the treatment determines the effectiveness of therapies to treat lazy eye. Causative factors for lazy eye can be easily picked up by a regular eye examination or eye screening and if present can be treated to prevent amblyopia.”

Insisting that early diagnosis and correct treatment is the key to successfully treat amblyopia, Dr Priyanka Singh said, “If Amblyopia is not corrected, it may lead to permanent vision loss and loss of depth perception which will affect further in life when the child grows. The younger the child, the better is the response. Up to the age of 7 years, the brain is highly receptive to improvements. The effectiveness gradually decreases after that. Although 50% of children do respond to treatment between 7-17 years of age.”

She suggested a few treatment options:

1) Correction of refractive errors by prescribing corrective glasses.

2) Patching of the normal eye up to few hours a day to improve vision in lazy eye.

3) Activity-based vision therapy in lazy eye to stimulate the brain.

4) Surgical correction of Cataracts, Squint, Corneal opacity, and Droopiness of eyelids.

For most children, correct and immediate treatment improves vision within weeks and treatment may last for few months or a year.

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