An 8-year-old with refractive amblyopia and best-corrected acuity 20/60 in both eyes and poor history of prescription use. Should they be referred to vision rehabilitation now?

• A. Yes, immediately
• B. Only if glasses are prescribed and worn
• C. No, should wear glasses first
• D. The case is inconclusive

Answer: (C)

The key idea is that fixing the optical input comes before any rehabilitative therapy. In refractive amblyopia, the first and most important step is to provide the correct glasses and ensure the child actually wears them consistently. This child has a poor history of prescription use, so the visual signal reaching the retina is likely suboptimal. Vision rehabilitation or amblyopia-specific therapy won’t work well if the eyes aren’t receiving a clear image, because the brain isn’t getting the quality input it needs to develop or re-balance vision.

So the immediate course is to prescribe the appropriate glasses and implement strategies to maximize wear time and adherence. Once the glasses are being worn reliably and acuity remains reduced or functional issues persist, then you can consider vision rehabilitation options and amblyopia therapy, keeping in mind that age makes improvement possible but less robust than in younger children.