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Question:
My 2-year-old has an appointment to be checked for amblyopia as it runs in his family. He is extremely scared of doctors and tends to cry and flail throughout his appointments. I was curious to know what a typical exam to test for amblyopia consists of for a 2-year-old.

Answer:
Amblyopia happens when there is lowered vision in an eye, which is anatomically normal. Most commonly this happens when the eyes are out of alignment and need straightening (called strabismus), when the eyes are very farsighted, or when there are unequal powers between the eyes (one eye is more farsighted, nearsighted, or astigmatic than the other).

Your doctor will ask you if you think the eyes look straight, and at age 2 this should be the case. He may ask you to bring in photos because amblyopic eyes tend to be out of alignment and the normal pattern is "red eye" reflex in both eyes. An amblyopic eye will consistently look dark while the normal one looks red in almost all photos where the child looks at the camera. You should see a pediatric ophthalmologist who will be skilled at dealing with infants and young children. They have many tricks to entertain and distract children so their fear of doctors is minimized. They have toys to look at, some that make noise, and some that dance around in a distracting and entertaining way. He will look to see if the eyes appear out of line and can look for the red reflex himself in a darkened room. A simple trick is to give the child something to look at and then cover one eye and next the other. If the child only cries when one eye is covered, this can mean that the other eye has reduced vision. The child won’t mind having a weaker eye covered as much as the good eye. The ophthalmologist will likely dilate (widen) the pupils which can help these examinations. It is rare that a pediatric ophthalmologist will fail to make this diagnosis, which just takes a little time and skill.

Answered by: Richard Bensinger, MD Dr. Richard Bensinger

Categories: Childrens Eye Health

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Answered: Jul 18, 2014

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