More ? about amblyopia in 9 yr old

My 9 yr old son was recently diagnosed with amblyopia.  His right eye is sphere +2.75, cylinder -1.00 axis 005 and his left sphere +0.50, cylinder -0.25, axis 005 .  His sight can only be corrected to 20/30.  His complaint was headaches, then right eye pain and seeing orange.  I took him to our optician and then a pediatric ophthalmologist.  Both agree to that script and to wear the glasses.  The optician wants him to patch in the evenings, where the PO does not.  The PO wants to do an MRI if the headaches do not stop with glasses.

We are ending day 5 with the glasses.  My son said he could see better with them, however the headaches (severe) continue and he now has eye pain in both eyes.  I called the PO who suggests we take the glasses back to the optician and have them checked and if the headaches cont. another week we'll do an MRI.  Later that day my son tells me he can't see well with the glasses anymore (reading or distance) and asked if he could take them off.  He's worn them all waking hours for 5 days.  I called the optician since it was late and he was open and he says he's just adjusting, etc.  He does not want to see him for 6 weeks.

I'm concerned about the headaches.  He takes ibuprofen 3x/day and I am sure he is having bad aches, he will lay down and cover his head with his arms... and just acts differently.  Another thing I've noticed is his head is almost always tilted to one side (the right side).  Is that typical?  His vision out of his right eye is dim compared to his left.

I don't know what I can do to help him.  Waiting another week is OK and an MRI, but his headaches have progressed over the summer.  He's always had them, but not as often or severe, they just seem to keep getting worse and worse.

Someone suggested a 3rd opinion, but honestly I just would like either of the two to take the time to explain this all to me.  I'm sure my son will like it if he didn't have to be dilated again!

[John C Hagan III, MD, FACS, FAAO]

1. Your son will see good with or without the glasses because the left eye is "good" and has virtually no refractive error.
2. The purpose of the glasses is to make the right eye see better.
3. It is unlikely that needing glasses will cause headaches like you describe.
4. If the right eye can see 20/30 with the glasses on its usually not worth patching.
5. I would get your pediatrician involved in this and proceed with an all out headache work up.
6. Remember that your other children, your nieces/nephews and ultimately grandchildren will have a 20% risk of amblyopia. They all need to be checked about age 2 to 3 by a pediatric ophthalmologist.

JCH MD