One of the most common childhood vision problems is amblyopia, or “lazy eye,” which occurs when one eye is significantly weaker than the other. But correcting the disorder can be hard, because kids often reject the treatment — a patch worn over the stronger eye.
This week, the journal Archives of Ophthalmology reports on a new study that compares patch therapy for amblyopia with another technique — a weekly regimen of medicated eyedrops that essentially work as a patch by blurring vision in the stronger eye.
Amblyopia is the most common cause of visual impairment in childhood, affecting 2 to 3 out of every 100 children. It can occur when when one eye is more nearsighted, farsighted or astigmatic than the other. As a result, the brain begins favoring the stronger eye, and the other eye gets weaker.
In the randomized study of nearly 200 children, giving the eyedrops on the weekend worked about as well as wearing a patch for two hours a day. The eyedrops work by preventing a muscle in the stronger eye from constricting. As a result, when a child tries to read or focus on something close, the good eye is blurred. That forces the weaker eye to focus and work harder, which helps it strengthen over time. Notably, when children look at far objects, the eye doesn’t need to focus, so both eyes can be used for far vision.
Some studies suggest that the biggest vision gains are made when the eyedrops and patches are used together. But since patches are often discarded by children, the drops are useful because parents control the treatment.
“Many children do not wear the patch and their vision does not improve,” said Dr. Mitchell M. Scheiman, a professor at the Pennsylvania College of Optometry in Philadelphia who led the recent study.”Once the parents put the drops in the child’s eyes, there are no compliance problems. The child now has to use the amblyopic eye for all near work.”
Dr. Scheiman says several studies show that the drops, which use the medication atropine, are safe. A few children may develop a fever or flushing, but they are typically switched to another medicated eyedrop. Medicated drops may make the children more sensitive to light because the pupil doesn’t constrict.
For more information about amblyopia, go to the National Eye Institute Web site.
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From 1 to 25 of 43 Comments
Our son was diagnozed with Amblyopia at the age of 4 and a half. He was heavily bribed to wear a patch almost all day for a year, until we were referred to an opthalmologist who recommended patching for just one hour a day while he played video games!. It worked very well: He went from being diagnosed with 20:200 in his weak eye to 20:40. The problem with patching — or drops– for long periods of time is that it affects depth perception — the child does not learn to use his or her eyes together.
— mirizmaybe it’s not a lazy eye…maybe the other eye is just an over achiever!
actually sounds like an interesting approach (as a former patch resister who has the drifty eyeball to prove it)
i wonder if the kids were at least amenable to wearing sunglasses since the other pupil doesn’t constrict…
FROM TPP - Good one. I wore a patch as a kid too. hated it.
— NYFMDocI’m a school psychologist, and I just read a student’s report that mentioned this form of treatment. It seems to be effective. I think the student’s vision is closer to normal now. I visit an ophthalmologist regularly, so I hope that someone explained to the student why bright lights hurt so badly. No one did when I first got my pupils dilated in 4th grade. I can still remember that painful and confusing day.
— DuaneThe madness continues.
Another drug. To replace an eye patch on a condition that affects 2-3 kids per hundred sounds like a big potential market with more doctor visits, more tests, more adverse reactions related to this drug. While compliance is a biggie for the profession, what needs to be examined are the results against palcebos, other treatment technigues and eye exercises. The quoted dotor says the eyedrops containing this drug show it is safe with a few side effects. Below is information about the adverse effects of this drug when taken intravenously. Most testing did not include children. It is a potent drug that seems up to this report on use in eye drops was mainly administered by needle. Notwithstanding that statement, this drug has some documented adverse side effects when administered by needle (see just a few adverse side effects of this drug below*).
Why is there no suggestion to try other non medical interventions first including eye exercises and attitude conditioning that makes this condition tolerable, acceptable and understandable to these kids and their peers? Or do we just force them via a patch or drops to do something? This is just the overmedicalization of another common condition that is part of life’s bumps?
*Side effects found at one website:
Most of the side effects of atropine are directly related to its antimuscarinic action. Dryness of the mouth, blurred vision, photophobia and tachycardia commonly occur with chronic administration of therapeutic doses. Anhidrosis also may occur and produce heat intolerance or impair temperature regulation in persons living in a hot environment. Constipation and difficulty in micturition may occur in elderly patients. Occasional hypersensitivity reactions have been observed, especially skin rashes which in some instances progressed to exfoliation.
Adverse effects following single or repeated injections of atropine are most often the result of excessive dosage. These include palpitation, dilated pupils, difficulty in swallowing, hot dry skin, thirst, dizziness, restlessness, tremor, fatigue and ataxia. Toxic doses lead to marked palpitation, restlessness and excitement, hallucinations, delirium and coma. Depression and circulatory collapse occur only with severe intoxication. In such cases, blood pressure declines and death due to respiratory failure may ensue following paralysis and coma.
* Contraindications, warnings and side effects from another site:
Contraindications
Atropine generally is contraindicated in patients with glaucoma, pyloric stenosis or prostatic hypertrophy, except in doses ordinarily used for preanesthetic medication.
Warnings
Atropine is a highly potent drug and due care is essential to avoid overdosage, especially with intravenous administration. Pediatric populations are more susceptible than adults to the toxic effects of anticholinergic agents…………………………..
Pediatric Use
Safety and effectiveness in pediatric populations have not been established…………..
Pediatrics
Dosing information in pediatric populations has not been well studied. Usage history of initial dose has been in the range of 0.01 to 0.03 mg/kg body weight.
FROM TPP — These side effects are due to excessive use, not a weekly treatment for less than five months, as is typical. Considering a lifetime of poor vision is the consequence of untreated amblyopia, all parents need to consider the risk benefit. This is not a pharma driven approach — these drops are generic and cheap.
— ed gI had a lazy eye as a kid, and my parents took me to an optometrist who had me do regular depth-perception “exercises” of various kinds (I had a weird little plastic device that held cards with double pictures I had to focus into one picture, for instance) for several years. No patches, and no surgery, which was the other option they were offered. As an adult I’ve had other optometrists disdain this as ineffective, and when I’m tired my eyes will still drift apart, but most of the time I use them together - you know, the way you’re supposed to. Reading this article I wonder if my optometrist was the only guy using that approach?
— PollyMy lazy eye was treated 30 years ago when I was in elementary school with the kind of approach Polly (#5) describes–”eye exercises” done at home and at the optometrist’s office. Additionally, I was supposed to watch one hour of TV per day with the TV tuned to black and white (apparently an option on 1970s TVs) while wearing plastic glasses that had one red lens and one green one. As I remember it, the purpose was to “train” me to use both eyes–if I was seeing both colors, that meant I was using both eyes. I don’t remember how long the treatments lasted–maybe a few months. My results are similar to Polly’s, too–my left eye seldom strays except when I’m (very) tired.
— YFI’ve worn glasses since age 3 for astigmatism and far-sightedness. Family lore is that I should have had them at 18 months. I was diagnosed with “lazy eye” at around 4 or 5.
They tried a patch–first aluminum foil(!), then I believe clear nail polish–but I did often give up and look over the top of my glasses.
At 53 the right eye is still dominant, though I’m left-handed. My corrected vision is good enough to let me work in a graphic design field, but I’ve wondered many times–could my left eye and/or brain connection be made stronger at this late date? And how much, if any, influence did it have over my life to have the quite weaker eye connected to the (apparently) dominant side of the brain? Thanks.
— Susan NunnDoes anyone know if amblyopia can be corrected as an adult ? I’m in my early 30s now, but would love to get it fixed. My lazy left eye has caused some right body dominance that is annoying.
— IdealistI was one of those noncompliant kids that refused a patch. I wish I hadn’t now but hindsight is 20:20 right?
Atropine is a potent IV drug but as a topical opthalmic agent (eyedrop) it should have little to no side effects apart from its local effects to the eye as long as the directions are followed. Those stated side effects are for IV administration and indeed IV atropine should not be administered by anyone not trained to use it. It is commonly used in cardiac arrest situations to speed up or restart the heart. This is an eyedrop to save a kids vision!!!! for the rest of his/her life!!!
PS I wouldn’t recommend injecting Visine IV either.
— STTo ed g and TTP,
Ed’s fear of pharma driven western medicine practices are a direct result of media driven hype. Many people doubt that doctors, hospitals, and research scientists throughout the western world continue to work hard to benefit their fellow man. We aren’t all in it for the money, and most of us wouldn’t conceive of intentionally harming another individual. Practicing medicine means understanding the balance between risk and benefit. Everything has risk. Sometimes risk is worth the benefit. Try writing some stories about the millions of physicians that donate time and resources to care for those in need. There are many of us that volunteer in free clinics or travel to third world countries. Help us get our face back.
PS. Ed… statistically speaking, driving your kid to school is a much bigger risk to them than giving them an atropine eyedrop. Let me see here….. driving risks include massive hemorrhage, loss of limb, paralysis, loss of vision, death to you or those around you… seems dangerous.
— STI was also treated similar to Polly and YF with exercises that I had to do every night (this is before Atari - so no video games to play with the patch). I remember the patch, but there was much more, similar to Polly’s description. Those exercises worked, at the very least to give me full awareness of what was going on and be able to correct my vision myself when I recognized I was seeing double (and to give my parents, teachers and other adults a cue that I was really paying attention but had this issue). Yes, my eye does drift occasionally (the tired factor as cited above)- but no prisms in these glasses and I reject this when offered by my optometrist.
I’m watching my young child like a hawk for that lazy eye, but drops that deliberately lessen the effectiveness of eyesight scare the heck out of me. What were the clinical trials with *pediatric* patients on the recovery of sight in the eye that received the drops?
As a last resort perhaps this makes sense (if the trials have shown that there’s no harm to pediatric patients), but only if the other options (i.e. exercises with both eyes, including the super cheap follow the pencil to your nose) don’t work after an appropriate course of treatment.
— HDThe things you learn :) I actually have strabismus in my left eye, and was never offered a patch or drops or surgery to correct it as a kid. Instead, I’ve had bifocals all my life. My eyes don’t work together - those 3-D things are hopeless for me because if I relax one eye, the other one jumps into focus.
I always wondered if a patch or these drops or whatever would have helped me. A bit of research has proven that nope, I’m just stuck with my glasses. (Strabismus can’t generally be corrected by a patch).
Go figure.
— rebeccaThe most important thing a parent can do in this situation is constant reinforcement - because the child will inevitably resist. I have worn glasses since I was 10 months old (as a result of a crossed left eye), and an eye patch for many childhood years. Even passive activities (watching TV, riding in the car) were difficult and even unbearably uncomfortable with a patch on my right eye. But my parents were consistent and creative in their encouragement - My teddy bear “had to wear glasses - Will you put on your glasses to make him feel better?” My patch became an essential part of an elaborate pirate costume that I wore on a regular basis.
Now, about 20 years later, my vision and crossed eye are corrected for a condition that doctors predicted would cause permanent loss of vision and a wandering eye. I wish all parents the resolve to address this issue while it can be reversed - They may be obstinate now, but they’ll thank you later.
— e. friendI was diagnosed with Amblyopia as a kid. I had to wear the eye patch and I also had drops for my good eye.
What I remember most to this day is this, as soon as mother dropped me off at summer camp - I took it off. I also remember telling others that I only had to wear it sometimes.
Drug companies make money off the drops - yes, but as someone who was prescribed a patch; Kids will figure out a way to remove the patch or cheat over glasses lens.
Anything to remove the patch is good, as a kid it is explained why you have to wear a patch. My parents gave me the best explanation. I understood that if I participated with the program my eyesight would get better. I thought that sounded good, as my lazy eye really bothered me spatially.
I still hated the patch, even the insert behind eyeglass frames. Its a similar feeling to being embarrassed by something publicly in High-school. It made me feel like running and hiding, and I was on the program.
— DrewI too suffered from this as a child. I went through patching and eventually 5 surgeries. Yet the strong eye won out and though I am cosmetically perfect the weaker eye is essentially useless. It was determined in my teens that the weak eye had an extrinsic fixation. The focal point was not in front or behind the focal point but off to one side of it. I do not know if this is a consequence or a cause for the initial amblyopia.
Yet it would seem to me that if a major ocular problem presented in just one eye that the brain would naturally work with the better eye. A corrective lens on the one side might amend that.
— DaveMy husband is blind in his left eye due to his “patch resistance” as a kid. I’ve mentioned to him that they now treat it with eye drops and his comment was “ok, I wouldn’t wear a patch…no possible way they’d have been able to hold me down for drops!”.
To bad there seems to be nothing on the horizon for the adults with vision loss due to this.
— ClareI had-and still have-a lazy eye. I was never perscribed a patch or drops, my mother was just told it was something I’d have to live with. Makes me wonder if the drops would work in an adult too, or if its too late for me?
— AndreaI have a niece, who had some kind of related problem with a wandering or crossed eye (I never really understood the cause…only the effect), and had to wear glasses from the time she was tiny.
When I took her on vacation, it was torture reminding her to wear her glasses. She tried to be brave and good-humored about it, but that eye and the glasses obviously chipped away at her self-esteem.
Eventually, she had surgery to straighten it out, but it was tough dealing with it through her early teens. Eye drops to treat the condition would have been a Godsend for her.
— WesleyMy child wore a patch and was prescribed atropine eyedrops 42 years ago for strabismus. The only thing that appears new to me is the application of the eyedrops once a week instead of daily, which is what we did then The opthalmologist described the atropine as a derivitive of nerve gas. That told me to be careful with it, and I was unfazed. Neither the patch (which did make her look like a “special” child, if you take my meaning, nor the eyedrops accomplished what he wanted, so she had surgery, which was successful. When she is extremely tired, her left eye turns in slightly. What I also learned then is that there’s no rescuing the vision if the problem is not dealt with by age 5 or 6. My own strabismus was so mild that it went unnoticed and I have incorrectibly poor vision in that eye at he age of 70.
— TeabiscuitYes, it is possible to treat amblyopia and even strabismus as an adult. You may want to explore options with a behavioral optometrist.
For strabismus, surgery corrects the cosmetic defect (which can be a real help for people!) but will interfere with proper use of the eye should one try to rehab it.
— Mango LassiI’m another adult with lazy eye, who was not offered a patch or any exercises as a child. I see only with my left eye for the most part unless I close it. Only then, does my right eye do any work. Now that I’m in my mid-40s, however, this is becoming more of a problem, as my “good eye” is being challenged, too.
— AnonymousI have this caused by damage to the optic nerve. Many if not most hydrocephalic kids have it, it is usually the first symptom that parents spot.
I had the patch treatment every day which was very traumatic. I had to have my elbows restrained (cardboard tubes) so that I didn’t pull it off. And it didn’t work.
Then my family changed opthalmologists to a much younger Dr, a hotshot in his speciality at the time and fairly young (mid 30s rather than early 60s). He told us:
1. this is easily correctible by surgery.
2. the patch can actually be dangerous in young children because the brain forgets to connect to the covered eye. You can actually damage perception of sight in that eye, sometimes in extreme cases to the point of blindness.
I had the surgery and next morning could see much better. The condition does relapse over the years, I had the operation again as a teenager (that time it was just day surgery and I was back at school in 2 days). I’m in my mid thirties now and due to have it redone and perhaps twice more in my lifetime. The surgery really is no big deal anymore.
I wouldn’t mess about with drops or patches, I’d just get the thing fixed as quickly and long-term as possible by surgery.
— JillyflowerAlso Mango Lassi is wrong (#20) the surgery does not damage the sight at all. In fact, you can have the surgery for strabismus on either eye often and it will work, so many surgeons will operate on the weaker eye, leaving the stronger eye unscarred just in case. But it only improved my sight and that of many people I know. Cosmetics has NOTHING to do with it. If I could see just the same with a lazy eye I wouldn’t bother fixing it just so people didn’t stare. It’s a good way to pick the rude people out.
— JillyflowerWhen my son was 2 yrs old,he had surgery on his rt eye for lazy eye. It was a total failure. He would not keep the post-op patch on and his eye floated severely to the right. Two years later, the ophthalmologist said he needed surgery on his LEFT eye to pull it inward! That theory being that when it healed, it would pull the right eye towards the nose instead of it floating outward. Again, a failure. We went through exercises, glasses with a patch. He is 32 now and has been very self-conscious about this. His eye still floats out when he is tired or upset. He has to consciously keep it straight. He has looked into correcting this but the options have never been great. Injections of botulism into the eye muscle was one. It would freeze the eye in one position and last 6 months. Eye surgery again was another. Not an option since he still has bad memories from his childhood surgery. If this drop is an option for adults, I’m sure he would be interested.
— BettyHow is this news? I’m 41 and was born with a strabismic right eye with astigmatism and very poor vision. I had a patch as infant, and years of treatment with drops during the 1970s — which gave me nothing but a sense of frustration as my “good eye” was blurry and I was forced to navigate the world with my weak eye. Reading was hard w/ the drops, sports were harder and I was miserable. Two corrective surgeries at 18 months and 15 years reduced drift, but I had a noticeably lazy eye until a 3rd surgery a year ago.
Growing as a girl with kids always asking me what was wrong with my eye, being teased about it by crueler kids, and feeling that it was an obstacle with boys throughout my adolescence was horrible. As a successful, happy adult woman, it was still a major step for me to finally get this last surgery and to feel free of being that girl with the “crazy eye.”
I would urge parents of children with similar issues to be very sensitive to the impact various treatment options can have on your child. The drops improved my vision and appearance not one whit but caused a lot of suffering (we did them every other day). The surgeries didn’t improve my vision either but each one did improve my appearance and my self-confidence — and 40 years later, I doubt it would take 3 surgeries to get a good result.
FROM TPP — Your experience was 40 years ago, and I can’t compare your diagnosis or treatment with the kids in the study.
— Elaine