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Researchers urge eye screening as early as age 1
Wanda Pfeifer uses a special purpose camera to screen children for amblyopia, also known as "lazy eye."
February 12th, 2013
11:53 AM ET

Researchers urge eye screening as early as age 1

How many times have you seen a young child with a patch over one eye or wearing glasses with one lens blocked and wondered why?  Chances are that child has something called amblyopia (sometimes called "lazy eye"), where one eye is not being used by the brain because it doesn't see as well.

After looking at more than 10 years of data, researchers now say children as young as a year old can be reliably screened for amblyopia; by using a camera that takes pictures of the eye, symptoms of the condition can be detected long before it becomes apparent, according to a study published Monday in the journal Pediatrics.

The goal is to identify children with this problem as early as possible, says lead study author Dr. Susannah Longmuir, "so we can start treatment before they have a problem or treat it before it gets worse."

She says very young children can already be developing amblyopia, but they do not know they have a vision problem because it's all they know - and they appear to parents to have normal vision. But as they get older, the problem gets worse.

One eye could be out of focus, or the eyes aren't straight and the brain doesn't want to see double, so it turns off the bad eye, says Dr. Daniel Neely, chairman of the vision screening committee for the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), who was not involved in the research.

The brain then gets used to not using the eye, he says.  But the brain can be re-taught how to use the eye that's just not doing enough – if caught early.  That's where the patches, glasses or eye drops come in. By covering the good eye up or putting eye drops in to make the vision in the good eye blurry, the brain is forced to used the other eye.

"We know that after age 5, the effectiveness of the treatment is diminished," Neely adds.  "The problem is most vision screenings happen when kids go to school," he says - close to when the window of correction closes.

"Current U.S. Preventive Services Task Force (USPSTF) guidelines, issued in January 2011, only recommend testing children for this eye condition between the ages of 3 and 5, citing insufficient evidence to recommend testing younger children.

The study

Researchers at the University of Iowa designed a study to help the USPSTF by providing the necessary evidence to include toddlers in their recommendations, says Longmuir.

"We wanted to see if we could reliably screen the younger children (1 to 3 year olds) just as well as the 3-5 year olds," says Wanda Pfeifer, who is not only a co-author of the study but also a orthoptist (vision therapist) who works with Longmuir.

Volunteers across the state were trained "to conduct free vision screening events with the MIT PhotoScreener," according to the study.  This is a special purpose camera that takes pictures of the eye - which look a lot like the unflattering "red-eye" in family photos.  It measures the optic of the eye and looks for risk factors for amblyopia.

One of the strengths of the study is that everybody used the same device. Longmuir says screenings were typically done at daycare centers where they could easily find the primary age group they were targeting - 6 months to 4 years of age - but no child was turned away.

She says 210,695 screenings of children's eyes were conducted from May 2000 to April 2011. The youngest children were 6 months old, the oldest were 7 to 8 years old. The average age was 3.4 years.

The results

The researchers found no statistically significant differences in the reliability of photoscreens in the 1- to 2-year-old age group compared with that in the 3- to 5-year-old children.

"If you are a year old, the test is going to be as reliable as if they (the children) are 3 years old," says Pfeifer, who read all of the thousands of screens.

The takeaway

Get your child screened as early as age 1 because if your child is developing amblyopia, his or her vision could be corrected.  "By 7 or 8, your vision is locked in," says Longmuir.

Neely says if your child fails a screening, then it's time for a full eye exam. Parents and pediatricians need to be aware of the benefits of this screening.  If your child hasn't been screened,  parents should request it, says Longmuir.

Just last week AAPOS revised its guidelines to include screening for children as young as 1.


soundoff (22 Responses)
  1. Meagan

    I wish I would have had my five year old daughter screened much earlier. As the article states, she appeared to have normal vision because she didn't know any better. She didn't show any signs of vision problems. Her right eye always turned inward since she was a baby but her pediatrician assured us that she would outgrow it. It wasn't until she went into kindergarten that her pediatrician became concerned and performed a vision screening. We found that she can not see well at all out of that eye. She now has to wear a patch and glasses full time. She is awaiting an operation to straighten the eyes but will still need the patch and glasses to gain vision. I wish we would have done something sooner so she does not have to go through with this. However, she is seeing an amazing specialist who is very optimistic about correcting the issue.

    February 12, 2013 at 13:50 | Report abuse | Reply
    • MC

      My child's dr also tried to tell me everything was ok. I insisted on seeing a specialist. I knew it was not normal. She ended up in bifocals and a patch.

      February 12, 2013 at 14:14 | Report abuse |
    • GypsyCat

      I had the same thing, and they caught it when I was 5. My optometrist – after I wore a patch – had me do exercises to straighten out my severely crossed ambyopic left eye. It worked, and today my eyes are normal without surgery.

      February 13, 2013 at 16:28 | Report abuse |
  2. NnbS

    interesting... I was patched at age 18 months. (this was 1962 a rare sight to see a child in glasses then) I wore a patch full time for a few years then not at school but at home for several hours every night until I was about 9 years old and it never helped. I'm still blind in my right eye (20/400 uncorrectable vision) so while I was patched early and often it did not help.

    February 12, 2013 at 15:03 | Report abuse | Reply
    • meggarsmom

      I was patched from kindergarten to junior high, it helped for a while but eventually my "bad" eye decided to be lazy again. My son has the same problem and our eye doctor told me when he was very young we could try drops, we could try patches but most likely all it would do would frustrate him. He told me since I know what it is like to grow up with a lazy eye that I already know he will be just fine.
      I love this eye doctor, I tried a different one once, he told me I would eventually learn to deal with my "handicap". Needless to say I never went back to him.

      February 12, 2013 at 22:48 | Report abuse |
    • Debbie

      NnbS,

      Patching is only part of the Amblyopia treatment. Patching helps the weaker eye develop better eye sight, but binocular vision exercises have to be performed to teach the brain how to use the two eyes together to develop depth perception. Otherwise, many people regress to have poor vision despite patching because one is so much more dominant, and the brain continues to suppress the weaker eye as the brain did not learn to integrate the visual stimuli coming from both eyes.

      February 13, 2013 at 01:27 | Report abuse |
  3. DaveFromAla

    Since infancy, I have had an eye that was turned inward. Treatments included surgery, patches, eye drops, special eye excercises, and glasses. None of the treatments worked for me, and I am still "legally blind" in my right eye. Perhaps the success rate of treatments has improved since I was a child (1970's). I can remember "cheating" some of the treatments by squinting or making a pinhole lense out of my fingers so I didn't have to cope with the blurry vision that the treatments often enforced on the good eye. As a child I probably thought that this was a clever way to get out of the blurry vision, but in the end I paid the price. While my treatments didn't work, I would still encourage anyone with a young child that has a turned eye to seek the opinion of a specialist!!! If your child is diagnosed with amblyopia, please be aware that there is no easy fix, even if diagnosed at an early age. You need to be very involved in the treatment and recognize that the treatments are not fun for the children, so they will often undermine them. This is the time to be a "helicopter parent" and keep on top of the doctors and your child to increase the odds of a successful treatment.

    February 12, 2013 at 16:23 | Report abuse | Reply
  4. Nichole

    I have strabismus and had surgery when I was 1 year old, I am now 38. I still wear glasses but I am so happy my parents took me to a Pediatric Optomologist when I was an infant. I also want to thank Dr. Redmond for being such a wonderful caring, competent dr. You are very missed, and very difficult to replace.

    February 12, 2013 at 21:45 | Report abuse | Reply
  5. Debbie

    I recommend patients experiencing amblyopia to read: Fixing My Gaze by Dr. Susan Barry. Barry had been cross-eyed and stereoblind since early infancy. She was able to develop good sight and depth perception through treatment received at 50 yrs of age.

    February 13, 2013 at 01:32 | Report abuse | Reply
  6. Children's Eye Foundation

    This is a great article about amblyopia. All the information you need is in the article...not the comments. Beware of those selling eye exercises. Nichole, I too knew Dr. Redmond and he is truly irreplaceable.

    February 13, 2013 at 09:12 | Report abuse | Reply
  7. Frank

    I was born with my left eye turning in. My mother put a patch on my right eye and made me use the left one more. The doctor said it wouldn't do much, but she could try. This was in 1974 and most doctors wanted to do surgery to fix it. My left eye has a little worse vision than my right, but patching the right eye kept my left eye from going completely bad.

    February 13, 2013 at 10:47 | Report abuse | Reply
  8. Sparkinton

    Granted, I am 30 and things have changed over the years.... When I was a small child doctors patched my good eye hoping my "lazy eye" would recover... meanwhile I bumped into everything, had bumps all over my head because of it, and was just miserable. I am blind in one eye... they need to to be looking for more than just a "lazy eye". Lazy Eye is a lazy diagnosis to me. I have Optic Nerve Hypoplasia. I think that more people should be screened, especially when they have a nystagmus, strabismus or any other kind of eye problems, really.

    February 13, 2013 at 13:43 | Report abuse | Reply
  9. John

    Same here – 1950's "medical" care . . . patches, surgery, glasses. Still blind in one eye, miserable experience growing up.
    If your child has anything resembling this problem, find a really well qualified doctor! And check his/her qualifications, experience and results before agreeing to any treatment, sure wish my parents would have had the means to do so.
    And that term, "lazy eye" is very demeaning, by the way.

    February 13, 2013 at 15:03 | Report abuse | Reply
  10. Stephanie

    At age 4, my pediatrician noticed that I was not seeing correctly and suggested to my parents that they should take me to a specialist. I had such bad vision in my left eye that my brain decided it wasn't worth it to use it. No muscular problems; although when I attempt to focus intently on something right up to my face, my left eye will turn inward. The ophthalmologist said that if we had waited any longer, my left eye would have gone completely blind. I wore a patch for some time and have been wearing glasses/contacts ever since (I'm 27). While I regained the use of my left eye, I still don't see perfectly from it. The best the doctor can do is 20/30 with contacts for that eye. It's as if I don't get the full picture; tiny spots are missing thoughout and the image tends to be dimmer when I close my right eye due to the missing spots. But my brain and eye movements fill in everything so I end up getting the whole picture. When I have children, I will definitely take them in early for testing!

    February 13, 2013 at 15:26 | Report abuse | Reply
  11. Lindsay

    After two surgeries left my eye still wandering, I spent years in therapy with Dr. Hellerstein in Denver. I learned to control my wandering eye to the point that it would only go "out" if I was sick or exhausted. I'm eternally grateful for her, she taught me how to use my eyes. I was monocular but the eye wouldn't drift out. Now that I'm older I wear contacts. Interestingly, I still don't see fully binocular without contacts, and fail depth perception tests, but I can catch a ball and haven't ever rear ended anyone...

    February 13, 2013 at 16:10 | Report abuse | Reply
  12. Karen

    By the time we caught my daughter's eye problems (at age 4), she was nearly blind in one eye (her brain had turned off that eye) She had very poor language, fine motor skills, and social development which turned out to be caused by not being able to see well close up–wasn't seeing faces or getting body language. She would also turn away from us when we tried to play games like patty-cake with her–it was like we were nothing more than big pieces of moving furniture. Many doctors thought she was on the autism spectrum.

    We learned later that her episdoes of head shaking and tilting her head to one side as a two year old were also caused by seeing double.

    If only we had gotten her tested as a one year old, we could have avoided so much grief!

    February 13, 2013 at 21:49 | Report abuse | Reply
  13. William

    I'm surprised that the InfantSee program has not been mentioned. It offers free eye exams for babies up to a year old. The earlier that eye problems can be detected, the greater the possibility of correcting them. The program's web site is at http://www.infantsee.org .

    February 15, 2013 at 21:55 | Report abuse | Reply
  14. DH

    Does the article mistakenly call the testing device a "MIT PhotoScreener"? I can only find a "MTI Photoscreener" online.

    I would really like to know how to obtain one of these devices and to be trained in using one. We lived overseas for nine years and my son, who is a voracious reader, wasn't diagnosed with amblyopia until we returned to the USA in 2011 he had a standard school eye exam, which he failed. But at age 11 the ophthalmologist who later treated him said they often don't even attempt to treat the condition, because it is usually set by that age. Fortunately, with patching and prayer, the Dr says the amblyopia is now gone, though my son does have to wear corrective glasses. I would very much like to see if I could purchase an MIT or MTI Photoscreener and become trained in its use, and then return to the country where we used to live to help some schools there conduct amblyopia screening. Can anyone give me information about how to obtain the device and the training? Thank you.

    February 19, 2013 at 10:00 | Report abuse | Reply
    • CJ

      DH it is an MTI Photoscreener. I’m not sure where to purchase one. I am a vision screener in the USA (Missouri) and use a plusoptix. It is remarkably easy to use with proper training. I do not work for plusoptix. A leading pediatric ophthalmologist from Washington University in St. Louis said it was the best auto refractor on the market. The web address is http://www.plusoptix.com/. If you click on contact on the left hand side you can send them an email and ask them more about buying one and training.

      February 20, 2013 at 16:42 | Report abuse |
  15. ML

    I have to disagree with Dr. Longmuir. Vision and visual ability is NOT "set" by age 7-8. We have had great success treating people up to 20 years old. In addition, full time patching or blur with drops is worse than part time patching coupled with visual tasks with the amlyopic eye..about 2 hours per day, at home.

    February 20, 2013 at 13:00 | Report abuse | Reply
    • CJ

      Do you treat all ages? If so how does your success rate very based on age? Are younger children more likely to respond positively to treatment? I work in vision screening like the people they are talking about in the Iowa study. I go to schools and daycares we focus on children 6 months to 6 years because we want to catch it early as possible. We are non-profit so we really do not have the resources to screen all age groups. I am just curious because I here all the time that by age 7 the brain is typically set in the way it treats the functioning of eyes and that it is rare for older children to have successful treatment options. I always want to learn more. Hope you have a chance to respond.

      February 20, 2013 at 16:50 | Report abuse |
  16. Shon Currier

    Ophthalmologists are physicians. They went to medical school. After school, they had a one-year internship and a residency of three or more years.`;,,

    Our new web blog http://healthmedicinebook.comag

    June 20, 2013 at 15:46 | Report abuse | Reply

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