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Amblyopia

“Lazy Eye”

In some children, sight doesn’t continue to develop properly in one eye even though that eye is structurally normal. This condition is called amblyopia (am-blee-oh-pee-uh) or lazy eye, because the eye seems to have lost the desire to see.

Amblyopia causes no discomfort, so the child will not be aware of the decreased vision since the other eye sees normally. Amblyopia is often discovered at a vision screening examination at the pediatrician’s office or when the child starts school.

What Causes Lazy Eye?

Each eye sends a slightly different visual image to the brain. Normally the images are similar enough to combine the images into a single image in the brain. If the two images are too different from one another, the brain cannot combine them, and results in double vision. Young children are able to avoid double vision by suppressing the image from one eye. Eventually the eye that suppresses images loses its ability to see clearly.

Why are There Two Different Images?

The most common conditions that can cause the eyes to send different visual images to the brain are strabismus (misaligned eyes; one eye looks straight ahead while the other turns in, out, up or down0 and anisometropia ( ann-eye-so-meh-troh-pee-uh) which means that the two eyes have very different optical  powers (for example, one may be normal and the other very farsighted or have extreme astigmatism).

Even if you could tell that your child has one of these conditions along with poor vision, you still have no way, on your own, of knowing whether one eye is “lazy”.

Treatment and Prognosis

Treatment must begin before school age to give the amblyopic eye the best chance of regaining normal vision. After the age of nine, the possibility of reversal is passed and amblyopia will remain for life.

If the cause of the lazy eye is an optical one, it will be treated first. Prescription eyeglasses may be necessary (eyeglasses can be worn by infants as young as a few months old). Although vision may improve somewhat with the glasses, it will continue to be poorer than in the normal eye.

If the eyes are misaligned, surgery may be necessary to straighten them. Surgical success is enhanced when the vision in both eyes is normal, so surgery will be delayed until the amblyopia has been treated.

Once the basic cause of the amblyopia has been identified and treated, vigorous program of patching or covering the good eye is necessary so that the child will use the amblyopic eye. It will take a lot of urging and patience, since you will be forcing the child to use an eye that sees poorly. (The patching does not correct any eye misalignment or eliminate the need for prescription glasses).

When the patch is on the good straight eye, the amblyopic eye straightens to the normal position for focusing. Most parents do not realize that the good eye under the patch then deviates. Eye exercises are also added to the treatment program in some cases.

An older child or an adult who has amblyopia or had previous treatment that did not result in perfect vision, can never expect to achieve perfect vision, even when wearing the proper corrective lenses (glasses or contacts).