Treatment for Vision Loss

Prompt diagnosis and early treatment are key factors for children with vision problems. The treatment interventions depend on the type of vision problem.

What Are the Medical Treatment Options?

Some of the medical treatment options that are used to correct vision defects and minimize loss include:

  • Antibiotics or antiviral drugs to help treat eye infections
  • Corrective lenses (glasses or contact lenses). These are used to treat refractive errors – such as nearsightedness (myopia), farsightedness (hyperopia) and astigmatism.
  • Patch therapy and other interventions for amblyopia. Amblyopia can be caused by misalignment of the eyes, farsightedness or astigmatism or cataracts. If detected and treated at an early stage – ideally during the first two to four years of life – amblyopia can be corrected. The earlier the treatment is started, the faster the recovery. If amblyopia is not treated before the age of eight, vision loss may be less responsive to treatment. Amblyopia is a reduction in vision that happens when the brain disregards the image received from an eye. That means that treating amblyopia calls for retraining the brain as well as the eye by forcing the brain to process visual images from the problem eye. Sometimes this can be accomplished just with corrective lenses (eyeglasses). Usually, though, doctors “disable” the healthy, stronger eye by putting a patch over it or using eye drops to blur vision. This method forces the “lazy” eye to work, thus strengthening its vision. It also makes the brain form new connections with that eye – rather than the one that it had been relying on. If a cataract is present, it may require surgery. If strabismus is the cause, it should be corrected after the vision has been equalized between the eyes.
  • Corrective lenses for strabismus. Strabismus is a misalignment of one eye so that its line of vision is not directed at the same point as the other eye. It is caused by an imbalance in the muscles that control the eye’s position or sometimes by near sighted vision. If left untreated, strabismus can lead to amblyopia and possibly permanent vision loss. Strabismus is treated by correcting of any refractive error with glasses, an eye patch to equalize vision, and, in some cases, surgery to alter the way the muscles pull the eye. The surgery may have to be repeated several times. Another option is injected medication to weaken an overactive eye muscle. If nonsurgical approaches do not work, then surgery may be performed on eye muscles to straighten the eyes. A set of eye exercises may be advised to correct faulty visual habits.

What Are the Surgical Treatment Options?

Some of the surgical treatment options that are used to correct vision defects and minimize vision impairment include:

  • Surgery to remove cataracts. Approximately six out of every 10,000 newborns have cataracts, a clouding of the eye’s internal focusing lens (an area that is normally transparent). Cataracts are one of the most curable causes of vision loss in early childhood and should be treated as promptly as possible in order to prevent blindness. A cataract not only blurs the image that the eye takes in, but it also interrupts the development of the visual pathways in the brain. A critical period of visual development takes place between birth and three to four months of age. If the brain does not receive clear visual messages from both eyes because of a cataract, then blindness may occur. The preferred method of treatment of cataracts in infants is to remove them surgically. After the surgery, the child must wear contact lenses or glasses to replace the eye’s natural lens, or receive a lens implant. If the child is dependable about wearing lenses or glasses, then vision progresses normally. But that may be difficult with younger children, who may not like wearing contact lenses all the time. For this age group, doctors recommend implanting an intraocular lens that replaces the child’s own lens. Children who have undergone cataract surgery should be followed closely by an ophthalmologist over a long period of time. Inflammation and glaucoma may occur, although sometimes not until years later. How well a child born with infantile-onset cataracts will see depends on a number of factors – including whether cataracts are present in one eye or both, the density of the cataracts, and the age at which the eyes are surgically corrected. But in the majority of cases, early diagnosis followed by suitable treatment can prevent blindness.
  • Laser surgery or cryotherapy (freezing) for retinopathy. A major risk factor for developing retinopathy of prematurity (ROP) is birth weight of 2.75 pounds or less, generally born before 31 weeks of pregnancy. The smaller the baby, the higher the likelihood that the infant will have ROP, which usually affects both eyes. Each year approximately 15,000 premature, low-birth-weight infants in the U.S. develop ROP. About 10 percent of these will develop severe cases of the condition that will leave about 400 to 600 infants legally blind each year despite treatment. Treatment for ROP consists of either laser therapy or cryotherapy. The medical term for both of these approaches is blood vessel ablation. While laser therapy uses heat from light energy, cryotherapy uses freezing temperatures to halt abnormal blood vessel growth. One consequence of both of these treatment approaches is a partial loss of peripheral (or side) vision. They do preserve central vision, which is the most important part of sight that we use to read, perform detailed tasks, or see faces. Traditionally, infants only received laser or cryotherapy when they reached a certain stage – a point at which about 50 percent of them would be expected to develop detached retinas if they were left untreated. But while treatment might prevent retinal detachment in many cases, vision was often still poor. Now a new study shows that premature infants will have better vision when therapy is given at an early stage of disease, rather than waiting for the 50 percent threshold.
  • Surgery to treat the tumors in the case of retinoblastoma. This is a rare cancer of the retina, which is the innermost layer of the eye located at the back of the eye. The highest incidence of this cancer is between infancy and two years of age. In about 25 to 30 percent of cases, the tumor affects both eyes. Treatment for retinoblastoma includes: chemotherapy, radiation therapy, laser or cryotherapy (a freezing process that destroys the tumor), phototherapy (use of light to destroy the blood vessels that feed the tumor), and enucleation (removal of the eye involved with the tumor). In addition supportive care (for the side effects of treatment), fitting and training for an eye prosthesis, blind or decreased vision adaptation training, and antibiotics (to prevent or treat infection) may be needed.

What Are the Non-Medical Treatment Options?

Once your baby comes home, there are different types of interventions that can be used to help make sure your child grows and develops normally. Early intervention programs for children with vision loss might include:

  • Vision aids
  • Occupational therapy to help with learning activities of daily living, fine motor skills and age appropriate play.
  • Orientation and mobility training (O&M) which helps your child learn such things as:
      • Sensory awareness: gaining information about the world through hearing, smell and touch
      • Spatial concepts: realizing that objects exist even if not heard or felt, and understanding the relationships which exist between objects in the environment
      • Searching skills: locating items or places efficiently
      • Independent movement: this includes crawling, rolling and walking.

Find Support

Have questions about vision loss?

Visit the My Child Without Limits support community and talk to parents, caregivers, and professionals about their experiences with vision loss.

Resources:

Want to learn more about vision loss?

American Association for Pediatric Ophthalmology and Strabismus
www.aapos.org

FamilyConnect (For Parents of Children with Visual Impairments)
www.familyconnect.org

Prevent Blindness America
www.preventblindness.org

The Association for Retinopathy of Prematurity and Related Diseases
www.ropard.org