Q: My daughter, 7 yrs old, suffers from AMBYLOPIA in her right eye. We dicovered this last year and started suggested exercises. At the begibning of treatment she was able to see only first letter on Test Chart but after a year she has reached 6/18 (partial). This has not improved further during the last couple of months. My query is: Can her sight improve further; is there a chance of sight deteriorating again and how can we hold her sight at current levels.

A:Amblyopia is a two-Snellen line difference of visual acuity (best corrected) from one eye to another. With best corrected vision of 6/18 in one eye and the other eye being 6/6 (I presume), your daughter has Amblyopia, as you very well know. Lets address the issue of Amblyopia by asking a few questions. The first question is what is the reason for the Amblyopia? It could be due to an eye turn (strabismus) or due a power difference between the two eyes (anisometropic). Less likely causes are due to a visual obstruction such as cataract (deprivational). It is important to try to ascertain why your daughter has Amblyopia. Now lets come to the important question that you asked - What can be done about treating Amblyopia? An extremely important concept to understand is that you only have upto 8 years of age of the child for any treatment to work. After she crosses 8 years of age, no treatment can help her. As she is 7 years of age now, you do not have much time to waste, and should give top priority to treating her Amblyopia. The classic and best treatment for Amblyopia is to put a full time patch on the normal better seeing eye. The patch is worn full-time during waking hours except for 1 hour per day. The child is patched 1 week per year of life. Your daughter is 7 years of age, therefore this means she gets a full-time patch for 7 weeks. Three cycles of full-time patching should be tried. Patching can be achieved by several different means and your doctor can tell you the best way. What you are doing by patching is to force the amblyopic eye to see and this will develop the vision in that eye. Do not worry about the patched better seeing eye, it will not lose vision. There are several alternatives to full time patching (like Bangerter films), but the most effective is full-time patching. I very strongly recommend it. Of course the refraction (cycloplegic) of the eye has to be determined and full correction (eye glasses) placed in front of the amblyopic eye. If there is an eye-turn, that can be corrected AFTER the vision in the two eyes have been equalized. You must seek the care of a pediatric ophthalmologist who specializes in strabismus surgery. I cannot stress it enough that you do not have much time left to make a very important contribution to your daughters vision. Two years from now, no one in the world will be able to help her. Eye exercises as you have suggested are NOT the appropriate treatment.