Digital Eyestrain
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Digital Eyestrain
Digital Eyestrain

Pediatrics & Amblyopia

Digital Eyestrain

One in four children has a vision problem that affects learning — a vision problem can sometimes be misinterpreted as or coincide with disinterest, sleepiness, dyslexia or ADHD. Eyesight (the ability to receive input through the eye) is not the same as vision (the ability to efficiently and accurately process and understand what that input is). Recognizing this distinction has monumental implications. Even a child with 20/20 eyesight can have a vision issue at the core of their learning problem. Being able to see the eye chart is just one of 17 different visual skills necessary for comfortable reading and learning.

To complicate matters, vision-related learning problems share the same symptoms as countless learning disability diagnoses, including:

  • Difficulty concentrating

  • Taking far too long and/or making mistakes when copying information from the board to the notebook

  • Rereading or skipping lines of print

  • Letter reversals

  • Difficulty recognizing words

  • Short attention span

  • Poor reading comprehension

  • Poor handwriting

  • Slow completion of work

  • Loss of interest in reading

  • Reduced visual memory - can't remember what we read, or difficulty remembering how a word is spelled

What types of pediatric services do you offer?

We know how important it is to have a comprehensive eye exam for our pediatric population.  Vision is crucial for learning and playing sports and it is so important to make sure that not only the eyes see clearly, but that they see comfortably and efficiently so that vision is not a barrier to learning.  We offer comprehensive pediatric eye examinations for kids of any age with or without a history of brain injury.

How is a pediatric comprehensive exam different from a neuro-optometric evaluation? 

Not every patient needs a comprehensive neuro-optometric evaluation or visual processing examination.  However, every pediatric patient needs a comprehensive, dilated eye exam to evaluate for any abnormalities like amblyopia (lazy eye) and screening of the oculomotor system to ensure overall normal binocular vision.  Binocular vision is the ability for both eyes to focus, coordinate, and track together efficiently. Underlying binocular vision disorders like accommodative insufficiency and convergence insufficiency are common in up to 30% of the pediatric population and can go undetected on a routine eye exams if not appropriately screened. Binocular vision disorders can occur in kids who have 20/20 vision and normal eye health, but cause difficulties with reading including headaches, fatigue, inattention, re-reading, losing one's place while reading, and more.  We offer RightEye eye tracking technology to evaluate what the eyes are doing when a child is reading and how accurate the eye movements are for reading.

A gif showing what it looks like to have blurry vision intermittently due to accommodative dysfunction
A gif showing what it is like to have an eye tracking disorder
A gif showing what it looks like to see double

What is amblyopia?

Amblyopia also commonly referred to as a "lazy eye" is when one eye has reduced vision due to an abnormal visual development early in life.  Amblyopia is a neuro-developmental disorder of the visual cortex and is thought to develop prior to the age 8, and can be caused due to asymmetric refractive error (farsightedness/astigmatism/nearsightedness) in one eye more than the other and/or if one eye turns more frequently than the other, known as strabismus.  Amblyopia is the leading cause of vision loss in children, and if not appropriately treated can lead to permanent vision loss.

What are symptoms of amblyopia?

Many children are completely asymptomatic for amblyopia, so without evaluation could go undetected for years.  Some children do show symptoms of impairment including reduced depth perception, rubbing an eye, shutting one eye or squinting, or having a wondering eye.

How is amblyopia and strabismus treated?

Early diagnosis and intervention can prevent long-term vision problems later in life, this is why a comprehensive pediatric eye exam is so important.  Treatment options for amblyopia depend upon the type of amblyopia but can include a range of treatment options including corrective glasses, patching, filters, eye drops, dichoptic vision therapy, and strabismus management.

Is there an age-cutoff for amblyopia treatment?

While studies have shown that the earlier (<7 years old) the intervention the faster and better the outcome, improvements in visual acuity of an amblyopic eye can occur after the age of 7 and even into adulthood.

How long does treatment take?

Proper treatment usually restores or improves within within weeks to months of initiating treatment, but may last months up to 2 years depending on the case.  Up to 25% of cases may regress so these patients may need ongoing follow up to ensure stability of treatment.

References

1. Holmes JM, Levi DM. Treatment of amblyopia as a function of age. Vis Neurosci. 2018 Jan;35:E015. doi: 10.1017/S0952523817000220. PMID: 29905125.

2. Levi DM, Knill DC, Bavelier D. Stereopsis and amblyopia: A mini-review. Vision Res. 2015 Sep;114:17-30. doi: 10.1016/j.visres.2015.01.002. Epub 2015 Jan 29. PMID: 25637854; PMCID: PMC4519435.

3. Cleary M. Efficacy of occlusion for strabismic amblyopia: can an optimal duration be identified? Br J Ophthalmol. 2000 Jun;84(6):572-8. doi: 10.1136/bjo.84.6.572. PMID: 10837378; PMCID: PMC1723515.