Pediatric and Teen CL Care
Treating Amblyopia: Then and Now
By Mary Lou French, OD, MEd, FAAO
Checking my schedule one morning, I saw I would be examining a 20-month-old child that day. Not so unusual, but a little younger than the children I commonly see. Then I noticed the home address was in San Diego. I do receive referrals from some distance away but mostly from the far suburbs of Chicago, where my practice is located. I was very curious about this patient.
Remembering Liza at Age 4
You know you have been in practice a long time when patients you saw when they were 4 years old bring in their own children to see you. Liza was 4 when I first saw her. She had a deeply amblyopic right eye, secondary to a relatively significant amount of hyperopia, and a left eye with an amount of hyperopia in the range of normal for her age. The refraction was +6.50D sphere OD, 20/200 BVA and +0.75D sphere OS, 20/20. Fortunately, Liza was a bright 4-year-old with a concerned and capable mom.
Being a fairly freshly minted OD and enthusiastic about the opportunity to put into practice some of the theories I had learned in school, I recommended fitting Liza with contact lenses and using a blurring contact lens to occlude the normal eye. Challenging as it was to explain to the mom that I was recommending contact lenses for her very young daughter, that was the easy part of the case presentation. It was far more difficult to explain the rationale of fitting her daughter with a contact lens that would intentionally blur the vision in her left eye, the better-seeing eye, all day, while wearing her contact lenses. Generally, the protocol for treating amblyopia today is not for all-day occlusion, but all-day occlusion was the standard of care at that time. One other consideration was Liza's age. She was not yet attending school.
Unfortunately, I treated Liza before disposable lenses became available, which meant her parents, who did not wear contact lenses, had to manage the care and expense of traditional lenses. Since then, I have fit many amblyopic patients with monocular contact lenses but have progressed to standard occlusion therapy supplemented with computerized amblyopia therapy, rather than the blurring contact lens fit I did with Liza. The newer protocol is just as effective and far less traumatic to the patient.
The occluding lens I prescribed for Liza was a +4.00D sphere, which blurred her left eye to about 20/60, which was enough for her to function and yet force the right eye to work, as well. By the time Liza was 7 years old, her visual acuity of the right eye was 20/40, while the left eye remained 20/20. For a few years, she continued with a monocular contact lens, then the family genetics took over and she gradually became myopic in the left eye and less hyperopic in the right, to the point where the formerly "bad" eye had become her better eye.
Liza now lives in San Diego, and her daughter, Amanda, was the patient on my schedule. A pediatric ophthalmologist near their home evaluated Amanda but appeared to be ambivalent about a treatment plan, which is why Liza brought her to see me. There is definitely the possibility Amanda has inherited her mother's problem, but at the moment, there is no evidence of amblyopia developing.
Today, I can still say with confidence, contact lenses are excellent tools for amblyopia therapy, even for patients as young as 4 years old. CLS
Dr. French is a graduate of Illinois College of Optometry. After earning her doctorate, she completed postdoctoral programs in learning disabilities, early childhood development and business management. She is a lecturer, author and industry consultant, specializing in children's vision. She is also a consultant or advisor to Vistakon. You can reach her at firstname.lastname@example.org