When apple of your eye gets a lazy eye
Medical entrepreneur Preeti Agrawal’s daughter Sharanya was barely three when she noticed that her little one repeatedly failed to locate objects at a distance. “My daughter used to draw a blank when I used to ask her to look at the sky, pointing towards an airplane. She would instead ask me, ‘where is it mumma?’ Initially, I thought as it is a flying object, she might have missed, but it was a regular phenomenon for her to miss out on such sightings. She couldn't spot anything barely at a hand's distance, and that ticked me off,” Agrawal recounts.
Her daughter's condition worsened when she joined school; she had to stand close to the blackboard to read and write in her notebook. The alarmed mother immediately took her to an ophthalmologist. Her worst fears came true; her three-year-old had lazy eye (amblyopia).
“Amblyopia is the medical term used when the vision in one of the eyes is reduced because the eye and the brain are not working in coordination. The eye itself looks normal, but it is not being used because the brain is favouring the normal eye and ignores input from the weaker eye,” says Dr Neeraj Sanduja, Senior Consultant, Fortis Hospital, Gurgaon.
Amblyopia is the most frequent cause of visual impairment in children and young adults with an overall prevalence of 2 to 4 per cent in most populations. It leads to decreased vision in one eye among children. Lazy eye rarely affects both eyes. Dr Sanduja says premature birth, family history of lazy eye and developmental disabilities increase the risk. It develops from birth and can occur anytime in early childhood (before the age of 7).
“Amblyopia can be caused by any factor that deprives the eye of visual stimulus (for example cataract which may prevent light from reaching the retina), any focusing problems or by misalignment of the eyes (squint) early in life. The severity of the problem may vary, and it may be graded as mild, moderate and severe,” says Dr Vishaal Bhambhwani from Centre for Sight, New Delhi.
Lack of knowledge and awareness may lead to late presentation and significant visual impairment. “The signs that one needs to watch out in a child include an eye that wanders inward or outward, poor depth perception, squinting or shutting an eye and head tilting,” says Dr Sanduja. Regular examination of the eye is vital to pick up any visual impairment, as the child may not be able to explain it. Also, the other eye is healthy, so it usually goes undetected for quite long.
It is important to eliminate the cause of lazy eye, and most of the treatments are based on the Amblyopia Treatment Studies. “Occlusion or patching of the better eye to stimulate the development of vision in the lazy eye is the most commonly used treatment. For children who do not tolerate patches, penalisation with atropine eye drops is an alternative. Other treatment alternatives include some pharmacological treatments and use of electronic devices for visual stimulation,” says Dr Bhambhwani. But for a child, wearing a patch is easier said than done. Agrawal had a tough time coaxing, cajoling, and at times scolding her daughter to wear the patch as long as she could in a day. The duo’s persistence paid off and the lazy eye is active now.
The earlier the treatment starts, the better are chances of improvement in sight. If left untreated, vision loss may range from mild to severe. “Parents must ensure that their children have their eyes tested as early as possible but before five, to detect this condition,” says Agrawal. Recently, while driving, her daughter now eight, suddenly pointed towards the sky to show her an airplane. “My joy knew no bounds when she could spot a flying plane. All thanks to timely intervention,” says the mother of two.