Initially, it is very liquid, and patching can change the vision within days. One analogy is that the visual system is like cement. By the same token, children are no longer at risk for losing vision when patching is discontinued. Once children have outgrown the amblyopic age group (between 7 and 10 years old), then the visual system is mature and further patching will not help. Because vision may regress when patching is discontinued, we often do parttime patching for years. Children need treatment (either a patch or atropine eye drops) until vision is equal in both eyes. Amblyopia is treated by penalizing the stronger eye. We all lose our ability to accommodate for near tasks as time goes by-the loss of accommodative effort over time is of benefit to children with accommodative esotropia, because they may outgrow the need for glasses and avoid muscle surgeryĪmblyopia. However, if the eyes are not aligned with glasses and/or bifocals, or if the child cannot be weaned from bifocals as he or she grows, then surgery may be indicated. If the eyes are aligned with spectacle correction, surgery may never be required. They are used so the child does not have to make the accommodative effort the eyes may not “turn in” and the child can use the eyes together, binocularly. The glasses may not improve visual acuity. Accommodative esotropia is treated initially with glasses. These 2 problems are associated-but are managed in different ways.Īlignment. If the child is wearing eyeglasses and a patch, then misalignment (most likely accommodative esotropia) and amblyopia are both being treated. Alignment can be more accurately assessed at about 3 to 6 months of age. During the first month of life, the alignment can vary from a small esotropia, to straight, to a small exotropia. Infants are rarely born with their eyes aligned. Disconjugate gaze can be normal during the first few months of life.
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