Visual acuity in the primary school child aged four to twelve years: a review of amblyopia treatment in this age group at Princess Margaret Hospital.

A survey of the incidence in Western Australia of amblyopia assessed through the school vision screening programme and Princess Margaret Hospital (PMH) eye clinics shows the figure to be 0.12%, being new cases detected in primary school children each year. Occlusion methods of treatment for amblyopia acceptable in the younger age-group are much less tolerated by both parents and child in the school-age group. The PMH series involving 240 children between the ages of four and 12 years showed that an amblyopic eye with macula or paramacula fixation can be successfully treated up to the age of 10 years without constant occlusion. Also, eccentric fixation can be cured up to the 7th birthday, but no alternative has been found for the mandatory constant occlusion. Medical, developmental and behavioural problems can influence the management and response in the four to twelve-year-old child; if these are not recognized and the child treated as a whole during the critical stages of natural development of the visual system, these children can be left with an unnecessary visual disadvantage for the next 70 years of their life.