Tammy first came to our office when she was six years old.  She had failed a school screening, the first indication she had an eye or vision problem.  The prognosis was very guarded with entering acuity of 20/100 in her amblyopic eye.  But her mother was a dedicated school nurse and was diligent in corrective eyeglass wear and patching.  Vision was improved to 20/20 in each eye and she actually achieved 100% stereo appreciation on the Randot Stereo Test.

But results were not easy and the patching was no fun.  So when Carrie was born, a trip to the eye doctor was high on the list in the first year of life.

Initial presentation was normal.  Carrie was healthy, held good fixation and maintained eye contact. 

Visual acuity tests were normal.  Eye muscle tests were normal, and eye alignment tests were normal. 

Distance retinoscopy indicated low hyperopia, but there was no change to against motion on nearpoint retinoscopy which gave an indication that we may be sitting on more plus than distance retinoscopy was telling us.

The key was cycloplegic refraction, where the full amount of hyperopia and low anisometropia became evident. 

The dilated fundus exam was unremarkable.

With this amount of hyperopia, positive family history of amblyopia, and an anisometropic situation we immediately began a conservative regimen of patching the less hyperopic eye (OS).  We rechecked Carrie at 3 month intervals and noted more balanced results. 

Carrie maintains close monitoring, but the patching, done at such a young age, was very easily accepted.  Prognosis is excellent for full acuity in each eye and full binocular function.

This is a unique photorefractive image of mom and baby demonstrating anisometropic amblyopia.  If you look at Tammy's eyes, the yellow crescent is in the top half of the pupil (myopia) of the right eye and the yellow crescent is in the bottom half of the pupil of the left eye (hyperopia).  This is a perfect scenario for anisometropic amblyopia, a condition undiagnosed in this case until age 6.  Early intervention on Carrie has a great potential for preventing amblyopia and the often difficult treatment if diagnosed at a later age.
Pre cyclopledia, Carrie demonstrates eye alignment but no indication of refractive error.
Post cycloplegia/dilation with 1% Tropicamide is a far different result.  There is a substantial amount of hyperopia with the anisometropia more evident on the left photo (axis 090).  Retinoscopy confirmed the anisometropia which prompted an early conservative patching regimen.