This is the right place to ask this.

I'd get the glasses made from doctor (A).

As far as occlusion is concerned, the main reason NOT to do it would be
because it's hard to get your daughter to comply with it - it's tough on
parents as well as the kid. Maybe doctor A just wanted to let her get
used to the glasses first before introducing another level of treatment.
But if doctor A agrees with doctor B that your daughter has amblyopia
then occlusion is what she needs. I would suggest occlusion for at least
a couple of hours per day, and get her to do eye-hand activities such as
colouring-in, mazes, etc while she is occluded. Depending on her level
of amblyopia this may be difficult at first - as her 'good' eye will be
occluded. If in doubt, occluding for 2hrs/day can't do any physical harm.

She may have very little or no stereoscopic vision but this does NOT
mean she has no depth perception.

If you are able to post the corrected visual acuity of the left eye,
that would be a help. Also, does she have a turned eye (esotropia)?

Dom

Don't panic, age 4 is early enough to correct her vision with good
results.   Either doctor's advice could be taken, it is important to
pick a doctor once you have a second opinion and stick with him/her;
bouncing between docs, switching treatment and so on will cause
problems.

Without knowing her best corrected acuity and thus the depth of
amblyopia it is hard to give more advice.  Personally, if the amblyopia
was not too deep, I would usually treat conservatively like Dr A has.
He is giving close to full correction then waiting to see if Mother
Nature will do the rest.  After 6 to 8 weeks of wearing the glasses,
she should be reassessed.  If the amblyopia is gone, great.  If not,
then patching can start.

Dr B is giving less correction to the left eye so Mother Nature is less
likely to help and patching will be needed.  Dr B should have
instructed you in how many hours a day and when to come back, if he
didn't call his office and ask.  Usually acuity is checked every two
weeks during patching.  Likely Dr B is planning on increasing the
correction as she adapts so at the end of day she will be weaing
glasses similar to Dr A's prescription.

If your daughter does not have an eye turn while wearing glasses, the
odds are very good that she will have normal vision in both eyes in a
few months; she will need to continue to wear glasses or contact
lenses.  And be reassured that even if the amblyopia went untreated
that it would not interfere with her education.

Dr Judy

I, like the other two eye doctors who have posted follow-up articles
in this thread, normally do not immediately patch amblyopes --
especially ones so young because vision often improves with spectacles
alone.

The sooner you begin therapy on an amblyope, the better the long-term
prognosis chances, but you've got quite a bit of time here before you
need to be concerned about the amblyopia not being amenable to
treatment.  This time frame in months and years, not days/weeks, but
once again, certainly the sooner the better.

As far as the exact Rx and treatment, there is a lot of art and
opinion rather than cut and dry.  Some doctors patch, while others use
atropine penalization -- there are dis/advantages to each method.

I wouldn't say Doctor "B" is "wrong" and "Doctor A" is right,
especially without examining the child.  And even after I examined the
child, I might think, "Well, it could go either way." as far as how to
treat her.

I would pick a doctor and make sure your daughter follows her
instructions religiously.  Failure with amblyopia therapy with someone
like your daughter almost invariably occurs because of patient
compliance with therapy rather than whether you choose doctor "A" or
doctor "B"'s therapy.

Make sure you/your daughter do exactly what the doctor instructs, and
maintain all follow-ups.  And if you have a question, obtain a consult
with another pediatric eye specialist and have your medical records
sent to his office.  He should be able to go over all the findings and
determine whether that doctor is following the commonly accepted
standards-of-care when it comes to treating your daughter, and whether
your daughter is responding to treatment as expected.

I would also recommend the following website:

    <http://public.pedig.jaeb.org/Completed_Studies.htm>

[snip]

It sounds like you have already done a lot, and as a father, I
understand the intensity of your concern when it comes to your
daughter.

However, if I was a lay-person, I personally would put a lot more
weight on the advice given to me by a known eye specialist that
actually physically examined my daughter than a, potential, "keyboard
Rambo" posting an article on the Usenet.  But that's just me...  :)

Doctor A found a cycloplegic difference between the eyes of 5.75D, and
Doctor B found about 7D, if I am reading it right.  Niehter Doctor A nor
Doctor B prescribed glasses taking this full difference into account. The
most was a 4D difference.

Now, since the cause of the amblyopia is one eye being out of focus when the
other is in focus, the treatment must consist of putting both in focus AT
THE SAME TIME. Meaning, you need the full difference in the glasses.
Depending in who you believe, it is either 5.75 or 7 diopters difference.
However, the list of numbers you showed lead me to believe this comes off an
automatic refractor. This may or may not be accurate, depending on the
fixation of each eye, and whether there are aberrations the autorefractor
can't interpret. In general, I trust my own retinoscopy (using my brain),
rather than trusting it to the autorefractor.

Without knowing the level of vision, and whether the eyes are truly
straight, I cannot recommend how much to cut the prescription, if all. Any
cut must be made equally from both eyes, so the lenses stay balanced for the
anisometropia.

At this age, IF the eyes are straight, the act of simply placing both eyes
in corect focus may allow the brain to use them, and the amblyopia may
slowly go away. If not, penalization (patching, or atropine drops if there
is not too much amblyopia) can be added later. I wouldn't expect a huge
change in a month or two, even, and only if the correct prescription is
used. If only 4 diopters of the 5.75 or 7 diopter is prescribed, that still
leaves the "bad" eye 1.75 to 3 diopters out of focus. It only takes about
1.5 difference to cause amblyopia in the first place, so leaving a big
difference will onl impede improvement.

If the eyes are not straight, the amblyopic eye will still be ignored, and
patching can commence at the beginning.

David Robins, MD
Board certified Ophthalmologist
Pediatric ophthalmology and adult strabismus subspecialty

On 6/6/06 6:25 AM, in article
1149600306.676033.255760@i40g2000cwc.googlegroups.com,

I found on wikipedia the following:

"The power of the eye's lens and cornea together is very high, about 40
dioptres, and the normal accommodation range of a young person is a
further 15 to 20 dioptres. Most of the power comes from the curvature
of the front face of the cornea, while the accommodation derives from
the soft internal lens being squashed by muscles. As we get older,
accommodation reduces, to about 10 dioptres at age 25 and around 1
dioptre or less at 50 and over, hence the almost universal need for
older people to use reading glasses."

Is this accurate?