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Help - 11 year old son with amblyopia
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LG
medicine forum beginner


Joined: 13 Jul 2006
Posts: 10

PostPosted: Thu Jul 13, 2006 9:39 pm    Post subject: Help - 11 year old son with amblyopia Reply with quote

My son, aged 11, has only recently (in the last 2 weeks) been diagnosed
with Amblyopia. He has excellent (6/4.5) vision in his left eye but is
very long-sighted in the right eye and can only read about 20% (6/30
just) in that eye without glasses. This is brought up to only about 50%
(6/12) vision in the poor eye with glasses. The eyesight problem has
only recently been diagnosed by chance, as he has never had any
problems reading or headaches - his left eye has been doing all the
work. I feel terribly guilty we did not spot this earlier, and am
anxious to do what I can for him before it is too late. Sadly, we were
told by the optician he is now too old for patching. However, after
doing some research on the internet, I have read that studies are being
carried out in the US patching older children with some positive
results. Then I came across some work by a team at Nottingham
University, developing a Virtual Reality system which sounds like it
might be even more suitable for my son. Furthermore I have come across
UK optomotrists on the internet who mention on their sites they are
happy to treat amblyopia in older children by patching and vision
therapy. I have also read about a treatment called IPS which might
help.

I am now totally confused as to who to approach. I emailed the
Nottingham team to see if they are carrying out further trials; they
are not right now, but they suggested I ring around a few consultants
before getting referred. However, getting consultants contact details
is proving hard without a referral and I don't really know what to ask.
What treatment should I be looking for? I went back to the optician and
she has agreed to write me a letter of referral if I can find someone
who will see my son, but because of his age, she suggested probably
only the Institute of Opthalmologists in London would be receptive to
seeing him. I emailed the Institute but have yet received no reply.

Can anybody out there please advise me what to do next. I live between
halfway between Oxford and Stoke Mandeville hospitals but according to
my optician, children over 8 are considered too old for treatment by
the hospital specialists and are referred straight back to the local
opticians. I know I can go to a private optomotrist - there is a good
childrens one in Cheltenham - but would an optomotrist be specialised
enough, or do I need to see an opthalmologist or orthoptist? How would
I find the right one and contact him/her?

I would be grateful for any advice anyone can offer. Having seen the
research going on, I cannot accept that my son is too old for treatment
at 11. Also would it be best to wait until he has had his glasses a
while to see what improvement they can offer to his VA before treatment
such as patching/ vision therapy is attempted - or bearing in mind his
age should he be starting treatment ASAP? (For information: currently
he has been prescribed a +4.25 lens for longsightedness in the poor eye
with -2.5 astigmatism correction. His actual longsightedness I am told
is actually +5.00. His good eye prescription is plano.) Many thanks.
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LG
medicine forum beginner


Joined: 13 Jul 2006
Posts: 10

PostPosted: Thu Jul 13, 2006 9:41 pm    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

Sorry, I forgot to mention, my son has no squint with this condition.
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LG
medicine forum beginner


Joined: 13 Jul 2006
Posts: 10

PostPosted: Thu Jul 13, 2006 9:45 pm    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

I would also be prepared to travel with my son to London or within 2
hours drive if anybody knows where I might find an expert in this field.
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David Robins, MD
medicine forum Guru Wannabe


Joined: 02 May 2005
Posts: 135

PostPosted: Fri Jul 14, 2006 7:44 am    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

On 7/13/06 2:39 PM, in article
1152826751.089325.283830@m79g2000cwm.googlegroups.com, "LG"
<lesley@goetz.eclipse.co.uk> wrote:

Quote:
My son, aged 11, has only recently (in the last 2 weeks) been diagnosed
with Amblyopia. He has excellent (6/4.5) vision in his left eye but is
very long-sighted in the right eye and can only read about 20% (6/30
just) in that eye without glasses. This is brought up to only about 50%
(6/12) vision in the poor eye with glasses. The eyesight problem has
only recently been diagnosed by chance, as he has never had any
problems reading or headaches - his left eye has been doing all the
work. I feel terribly guilty we did not spot this earlier, and am
anxious to do what I can for him before it is too late. Sadly, we were
told by the optician he is now too old for patching. However, after
doing some research on the internet, I have read that studies are being
carried out in the US patching older children with some positive
results. Then I came across some work by a team at Nottingham
University, developing a Virtual Reality system which sounds like it
might be even more suitable for my son. Furthermore I have come across
UK optomotrists on the internet who mention on their sites they are
happy to treat amblyopia in older children by patching and vision
therapy. I have also read about a treatment called IPS which might
help.

I am now totally confused as to who to approach. I emailed the
Nottingham team to see if they are carrying out further trials; they
are not right now, but they suggested I ring around a few consultants
before getting referred. However, getting consultants contact details
is proving hard without a referral and I don't really know what to ask.
What treatment should I be looking for? I went back to the optician and
she has agreed to write me a letter of referral if I can find someone
who will see my son, but because of his age, she suggested probably
only the Institute of Opthalmologists in London would be receptive to
seeing him. I emailed the Institute but have yet received no reply.

Can anybody out there please advise me what to do next. I live between
halfway between Oxford and Stoke Mandeville hospitals but according to
my optician, children over 8 are considered too old for treatment by
the hospital specialists and are referred straight back to the local
opticians. I know I can go to a private optomotrist - there is a good
childrens one in Cheltenham - but would an optomotrist be specialised
enough, or do I need to see an opthalmologist or orthoptist? How would
I find the right one and contact him/her?

I would be grateful for any advice anyone can offer. Having seen the
research going on, I cannot accept that my son is too old for treatment
at 11. Also would it be best to wait until he has had his glasses a
while to see what improvement they can offer to his VA before treatment
such as patching/ vision therapy is attempted - or bearing in mind his
age should he be starting treatment ASAP? (For information: currently
he has been prescribed a +4.25 lens for longsightedness in the poor eye
with -2.5 astigmatism correction. His actual longsightedness I am told
is actually +5.00. His good eye prescription is plano.) Many thanks.


Amblyopia diagnosis is based on the best corrected vision. The amblyopic eye
here is 6/12 (or 20/40 in US terms). The other eye is about 20/15.

This does not constitute bad amblyopia, and may explain his relatively good
stereo vision. If the eye was 20/100 or 20/200, the stereo would be much
worse.

The latest studies on amblyopia (see the PEDIG study reports in
ophthalmology) in kids even up to age 17 show that some improvement can be
obtained in the older age group. His age of 11 is still at the younger end
of the previously "unpatchable" ages range. Ie: we didn't used to patch over
age 8. Now most of us go to age 10, and I have patched an 11 year old with
good outcome. Of course, if the amblyopia is severe, the chances are
smaller. But if starting with a 20/20 eye, I think he may have a reasonable
chance of improvement. Since it has been this long, waiting a couple of
months to see if there is some change just with the lasses alone is probably
OK. Patching does not HAVE to start ASAP. I would not wait too long (more
than 6 months) however.

Atropine penalization may be useful here, because the amblyopia is not
severe, and getting an 11 year old to patch is hard. At least the atropine
can give him some treatment while in school, etc., and you could add patch
at home after school. It will take a longer time that in younger kids, but
you have to stay on it and watch. If no change is 6 months of
atropine/patch, tehn I'd probably give up. But if it is improving, then keep
it up until there is no more evidence of gain for at least several months.

In any case, the people who told you flat-out he cannot be treated are
probably mistaken. I don't have many contacts in England, but I do know
David Taylor in London, a well-known pediatric ophthalmologist.


David Robins, MD
Board certified Ophthalmologist
Pediatric ophthalmology and adult strabismus subspecialty
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JohnDoe
medicine forum Guru


Joined: 14 Jun 2005
Posts: 364

PostPosted: Fri Jul 14, 2006 10:22 am    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

LG wrote:
Quote:
I would also be prepared to travel with my son to London or within 2
hours drive if anybody knows where I might find an expert in this field.


Can't vouch for any particular individual on this link but I'd imagine
that most of them would be comfortable to take on your son's case:
http://www.babo.co.uk/memberlist.html

I agree with the other posters that full-time glasses, or better still
contact lenses, in conjunction with patching is well worth trying. Maybe
wearing the specs(CLs) for a month or so initially to get a baseline
before starting patching.

Don't feel too guilty about not realising your son had this problem as
you weren't the first parent and won't be the last to assume that
everything's OK in the absence of any signs or symptoms. As long as your
son doesn't dream of being a RAF fighter pilot or opening bat for the
English cricket team, it won't affect his life too much. More people
than you might realise are amblyopic. Apart from the immediate actions
already discussed, the best thing you can do for him in the medium term
is to be aware of eye protection for sports, kids games, and other
potentially hazardous situations.

Dom
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LG
medicine forum beginner


Joined: 13 Jul 2006
Posts: 10

PostPosted: Fri Jul 14, 2006 12:01 pm    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

Dom wrote:

.. Apart from the immediate actions
Quote:
already discussed, the best thing you can do for him in the medium term
is to be aware of eye protection for sports, kids games, and other
potentially hazardous situations.

Dom

Thanks for the kind words; well I have bought him protective sports
goggles last week so I have done something right.

Many thanks for the link - it will be very useful. Do you think a
behavioural optomotrist is better than an opthalmologist and/or
orthoptist in my son's case? I don't really understand the difference.
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JohnDoe
medicine forum Guru


Joined: 14 Jun 2005
Posts: 364

PostPosted: Fri Jul 14, 2006 2:05 pm    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

LG wrote:
Quote:
Dom wrote:

. Apart from the immediate actions
already discussed, the best thing you can do for him in the medium term
is to be aware of eye protection for sports, kids games, and other
potentially hazardous situations.

Dom

Thanks for the kind words; well I have bought him protective sports
goggles last week so I have done something right.

Many thanks for the link - it will be very useful. Do you think a
behavioural optomotrist is better than an opthalmologist and/or
orthoptist in my son's case? I don't really understand the difference.


It's a huge oversimplification with many exceptions, but optometrists
specialise in vision, and ophthalmologists specialise in medical
conditions of the eyes.

For your son I think it's not so important whether optometrist vs.
ophthalmologist, but that whoever you see has a special interest in kids
vision and has experience in amblyopia treatment. Each profession has
some members who are great with kids and others who admit that they'd
rather not see any kids in their practice at all.

Dom
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LG
medicine forum beginner


Joined: 13 Jul 2006
Posts: 10

PostPosted: Fri Jul 14, 2006 3:25 pm    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

Dom wrote:

Quote:
It's a huge oversimplification with many exceptions, but optometrists
specialise in vision, and ophthalmologists specialise in medical
conditions of the eyes.

For your son I think it's not so important whether optometrist vs.
ophthalmologist, but that whoever you see has a special interest in kids
vision and has experience in amblyopia treatment. Each profession has
some members who are great with kids and others who admit that they'd
rather not see any kids in their practice at all.

Thanks Dom for clearing that one up - you've been really helpful!
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LG
medicine forum beginner


Joined: 13 Jul 2006
Posts: 10

PostPosted: Fri Jul 14, 2006 3:41 pm    Post subject: Re: Help - 11 year old son with amblyopia Reply with quote

David Robins, MD wrote:

Quote:
This does not constitute bad amblyopia, and may explain his relatively good
stereo vision. If the eye was 20/100 or 20/200, the stereo would be much
worse.

The latest studies on amblyopia (see the PEDIG study reports in
ophthalmology) in kids even up to age 17 show that some improvement can be
obtained in the older age group. His age of 11 is still at the younger end
of the previously "unpatchable" ages range. Ie: we didn't used to patch over
age 8. Now most of us go to age 10, and I have patched an 11 year old with
good outcome. Of course, if the amblyopia is severe, the chances are
smaller. But if starting with a 20/20 eye, I think he may have a reasonable
chance of improvement. Since it has been this long, waiting a couple of
months to see if there is some change just with the lasses alone is probably
OK. Patching does not HAVE to start ASAP. I would not wait too long (more
than 6 months) however.

In any case, the people who told you flat-out he cannot be treated are
probably mistaken. I don't have many contacts in England, but I do know
David Taylor in London, a well-known pediatric ophthalmologist.

Thanks David, this has all been so reassuring to hear!
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amblyopia
medicine forum beginner


Joined: 08 Dec 2008
Posts: 1

PostPosted: Mon Dec 08, 2008 7:57 pm    Post subject: read about this treatment that worked; games and bowling Reply with quote

Hi, Feel hope.
You don't need to fly to London.
Try using computer games and bowling and similar sports while patching. One family brought their child from 20/400 (legally blind) to 20/20 in only 4 months.

The key might be to do a sport that forces your eye to track a ball in order to hit it (while patching)

A detailed description is here
http://www.kidslike.info/how_to_treat_your_childs_amblyopia

Good luck
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