Hyperopia and amblyopia in 3-year-old

[bbalta]

We took our 3-year old son to an opthalmologist first at age 1 and then last November (before turning 3) since we were suspicious of strabismus (one of his eyes seemed to be sliding). Last November the doctor said no issue, it seemed like the eyes were sliding because of the nose bone structure. Our pediatrician advised us to see another opthalmologist last month. Luckily we followed her advice and the new doctor confirmed the diagnosis of no sliding (again looks like it due to bone structure) but became suspicious of amblyopia (lazy eye). After some tests, she discovered that the left eye was pretty lazy and prescribed eye drops to investigate the situation further. It turned out that he had hyperopia and was prescribed w/glasses:  +1.75 (right eye) and +2 (left eye). She also wants us to cover the "good" eye 1 hour a day so that the lazy eye improves. We will go for another check in 3-4 months.

Hearing about the fact that the eye naturally improves as children grow, I want to be sure that glasses are definitely necessary as it's so hard for a very active child to wear glasses. We just got the glasses today, should we continue with the glasses? Would hyperopia diminish by wearing glasses and if so by what age? (i.e. how long would he be wearing glasses?) How long would the "covering" treatment continue to take care of the lazy eye situation?  I kown that these would vary from child to child , but a a rough average timing would also be helpful. Are we talking about weeks, months or years in each case for example?

Is there anyone whose child has gone through a similar process? How has the situation prgressed?
Thanks a lot for your answers

[Dr_ZaPaS]

Optic correction left eye must be most suitabling. This depends from its refraction, but not from better sighted eye. In moderate amblyopia (20/40 to 20/80), start patching by prescribing 2 hours a day combined with 1 hour of near visual acuities. This decreased burden of patching may be more acceptable to both the child and the parent.
3-4 mouth period may do it. And visit your doctor.

[bbalta]

He was able to read 6-7 lines at a distance with the right (good) eye, but had problems on the 2nd-3rd line with left one. He said he could not see. I don't know the actual refraction , the doctor prescribed +1.75 (right) and +2.00 glasses. Don't know if this is less than the actual refraction or not, but she said that even though there is not that much refraction difference between the two eyes, the left one is lazy, so we need to patch the good eye 1 hr a day so the left eye improves, too.
She said that when we come back in 3 months, having used the eyeglasses and done the patching as prescribed, a good result would be for him to read additional lines with the left one and for his refraction to have stayed the same and not increased. Does this sound reasonable?

[Dr_ZaPaS]

How many child saw test-line picture (or visual acuity)?
I think that little hyperopia is good refraction at this age. How measured refraction?  

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

Your child will need to be watched carefully till he's about 17 or 18. He is likely to need glasses and patching till age 7-8 and after that glasses or contacts.

Without glasses/patching he will likely have poor vision in one eye (amblyopia) and the crossing will likely degenerate into constant crossed eyes that are diffiult to fix with surgery.

JCJH DM

[bbalta]

Thanks for the fast reply. By wearing the glasses and patching as recommended 1 hour a day, would his situation improve? And typically over what type of a timeframe?

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

The eyes don't improve with age. In fact strabismus and amblypia often get much worse and more difficult to treat. Some children get less farwighted as they get older but that has nothing to do with whether they need glasses, patching, bifocals when younger.

Your child needs to wear the glasses and likely will need patching.

Other children in your family have a 20% chance of the same problem so have everyone checked.

JCH MD