Lazy eye and squint treatment in Malaysia: patching, glasses, surgery and what decides the cost

Lazy eye (amblyopia) in a young child is treated by making the weaker eye work: glasses where the prescription is part of the cause, a patch over the stronger eye, atropine drops that blur it, or both, and squint (strabismus) may also need eye muscle surgery. Trials show real gains from each. The cost is decided by visits, glasses, any surgery and follow-up, and this page names no price.

Dr Chan Li Yen, paediatric ophthalmologist in Petaling Jaya, writes this journal; the About page says where she practises. A squint and a lazy eye are different problems that often travel together, and the parent's guide to squint and lazy eye explains the difference.

How is lazy eye treated in children?

The American Academy of Ophthalmology (AAO) says amblyopia is usually corrected by making the child use the weaker eye. That is done by a patch over the stronger eye, eye drops that blur the stronger eye, or glasses with a lens that blurs it. It generally takes several months for vision to get stronger.

Once the weaker eye has improved, the AAO says a child may need to wear the patch part-time for a few years to keep it strong. Treatment also deals with the cause: a squint, a prescription that differs between the eyes, a cloudy lens or a droopy eyelid can each be behind a lazy eye.

Can glasses alone treat a lazy eye?

Sometimes they do a great deal. In a trial of 84 children aged 3 to under 7 with untreated amblyopia from unequal prescriptions, glasses alone improved vision by at least 2 lines on the eye chart in 77% and cleared the amblyopia in 27%. Improvement went on for up to 30 weeks before it levelled off.

The researchers concluded that glasses alone resolved the amblyopia in at least one third of these children, and that the average gain of 3 lines may lessen the patching needed afterwards. Results were better when the starting vision was better and the difference between the eyes was smaller. Glasses are therefore often where treatment begins when the prescription is part of the cause, and the doctor decides after re-testing whether a patch is still needed.

How many hours a day, and for how long, is a patch worn?

For moderate amblyopia, a trial found that 2 hours a day worked about as well as 6 hours. It randomised 189 children under 7, and in both groups vision improved by an average of 2.40 lines over 4 months, with the acuity reaching at least 20/32 or improving by 3 or more lines in 62% of each group. The children also did at least an hour of close-up activities, such as drawing, during patching.

The hours, and how long the course runs, are set by the doctor from how dense the amblyopia is. Helping your child wear the patch covers the daily practice, and lazy eye apps and games covers what screens can and cannot do.

Can atropine drops be used instead of a patch?

Yes, for moderate amblyopia the two work in a similar way. In a trial of 419 children under 7, vision in the weaker eye improved by 3.16 lines with patching and 2.84 lines with atropine over 6 months. Acuity reached 20/30 or better, or improved by at least 3 lines, in 79% of the patching group and 74% of the atropine group.

Improvement was faster at first with the patch, and atropine had a slightly higher acceptability on a parent questionnaire. More children in the atropine group had a temporary dip in vision in the stronger eye, which did not last. Atropine drops instead of a patch for lazy eye explains how it works day to day.

How is a baby's or child's squint treated?

That depends on the type, and the first step is a proper examination, because a baby's eyes under about a year can look crossed when they are not. The AAO calls this pseudostrabismus, and says it usually comes from a wide, flat nose or a fold of skin at the inner eyelid. A baby whose eyes truly turn is treated according to the cause, and when to see an eye doctor for a squint in a child sets out the signs.

The AAO lists three levels of treatment. Glasses can correct a squint in a child whose blurry vision makes the eyes cross or drift. Patching or eye drops strengthen the weaker eye, which can make it easier to hold the eyes straight. And sometimes surgery on the eye muscles is needed. Surgery does not replace glasses, patching or blurring if the doctor recommends them as well.

What does squint surgery involve, and how long is recovery?

It loosens or tightens the eye muscles to change the alignment of the eyes, and the AAPOS (the paediatric eye surgeons' association) says most children have it under general anaesthesia as an outpatient, without staying overnight. No skin incision is made and the eyeball is not removed. The AAO says most children are back to their daily routine in about 2 to 3 days, and some children need additional surgeries.

The white of the eye is normally red after surgery, and the redness may take several weeks or occasionally months to clear. Squint surgery: what happens on the day, after squint surgery and squint surgery in Malaysia: the wait and what to ask go through each stage.

What decides the cost of lazy eye and squint treatment in Malaysia?

The cost is decided by how many visits are needed, which treatments are used, and whether surgery is part of the plan, so this page quotes no figure. Amblyopia treatment runs for months to years, and the AAO says appointments need to be kept so vision in both eyes can be monitored. The parts to ask about are:

• The first examination, including the drops that relax focusing and the eye health check.
• Glasses: the lenses and frame, and replacements as the prescription changes or a pair breaks.
• Patches or atropine drops, and the follow-up visits that measure vision on the chart.
• Surgery, if advised: the surgeon's fee, the anaesthetic, the facility and the post-operative checks, billed together or separately.
• Whether you go through the public route or a private clinic, and what each charges for the same step.

In the public route, a klinik kesihatan or GP refers the child to a government hospital eye clinic, and the referral letter and earlier glasses prescriptions go with you. In the private route, an eye clinic that sees children is booked directly, and a written estimate before any step is reasonable to ask for. Looking for a doctor near you? The register check is the same in either route: how to check a children's eye specialist is registered shows the steps.

Common questions

References

1. American Academy of Ophthalmology · Amblyopia (lazy eye) · www.aao.org
2. American Academy of Ophthalmology · Strabismus in children · www.aao.org
3. American Association for Pediatric Ophthalmology and Strabismus · Strabismus surgery · aapos.org
4. Ophthalmology 2006 · Treatment of anisometropic amblyopia in children with refractive correction (Pediatric Eye Disease Investigator Group, Cotter et al.) · pubmed.ncbi.nlm.nih.gov
5. Archives of Ophthalmology 2003 · A randomized trial of patching regimens for treatment of moderate amblyopia in children (Pediatric Eye Disease Investigator Group, Repka et al.) · pubmed.ncbi.nlm.nih.gov
6. Archives of Ophthalmology 2002 · A randomized trial of atropine vs patching for treatment of moderate amblyopia in children (Pediatric Eye Disease Investigator Group) · pubmed.ncbi.nlm.nih.gov

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.