Bilateral Refractive Amblyopia (Myopic)

[worried_dad]

My 8.5 year old son has been diagnosed wih Bilateral Refractive Amblyopia of 20/40 in both eyes.  Apparently this was caused by being slightly undercorrected for myopia with his old glasses and development of astigmatism over the last year.  His new perscription is OD (-6.25 with -1.25 astigmatism) and OS (-5.75 with -1.75 astigmatism).  The doctor said that the standard procedure is to fully correct both eyes and check them frequently for improvement in acuity.  No patching was indicated at this time.  

With his new glasses on he is able to read the 20/40 line on both a far (20 feet away) and near (14 inches away) eye chart.  It was observed that by reducing his prescription by about 1.5D, he was also able to read the 20/20 line on the near eye chart.  He was not able to read the 20/20 line on the far chart with any correction.

My son finds his new glasses very strong and hard to get used to.  Will this not cause further rapid myopia progression?

What is the prognosis for someone his age recovering his visual acuity?  

In cases of myopic amblyopia as this, does recovery depend more on the near stimulus or far?  i.e. Should we be engaging him in more near point activities or far point activities?  I guess, providing there is no myopia progression, if he is able to read the 20/20 line on the near eye chart, he should be able to do so as well on the far chart.

My concern is that the myopia will progress rapidly thus requiring the glasses prescription to be frequently increased to keep up.

Any insight regarding these types of cases with regards to my questions would be appreciated...

Thank You.

[jordan6]

A related discussion, Schoool Resources? was started.

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

No it doesn't work that way there are several factor that may make the distance better than near or vice versa.

Example of distance better than near: a 55 year old man without his reading glasses on
Example of near better than distance: a 55 year old man with nuclear cataracts without glasses

JCH III  MD

[worried_dad]

After an eye checkup today my son is able to see 20/30 in both eyes on the far eyechart (20 feet) and 20/20 on the near eyechart (14 inches away).

The vision could not be corrected better than 20/30  on the far chart.

My question is, how is this possible?  If he can see 20/20 on the near eyechart, should he not be able to see the same on the far chart with proper visual correction?

Thanks.

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

By age eight and a half any refractive amblyopia will likely not get better but also will likely not get worse. On the other hand problems like myopic degeneration may develop.  He should have enough ability to focus that he does not need under-corrected. In fact undercorrection for distance would be a major problem.

Some eyes even with less refractive error do not have the ability to see 20/20.  Vision over large populations is largely distributed over a Bell shaped curve with 20/20 being average. The point I'm trying to make is that some eyes that don't need glasses and have no disease may not see 20/20.

When you child is older contact lens will give better vision than glasses.

I suggest you have your child under the care of, or at least consult, a pediatric ophthalmologist for a review of his individual situation.

JCH III MD  Eye Physician and Surgeon