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Amblyopia / Lazy Eye

Lazy eye pictures, lazy eye in picture

AMBLYOPIA OR LAZY EYE

Amblyopia or Lazy eye is one of those conditions that your child eye doctor or child eye specialist will treat with lazy eye exercises or eye patch for lazy eyes.  More about that later in this text.

WHAT IS LAZY EYE MEANING OR AMBLYOPIA MEANING?

Let me start with a story. Let’s say that cute twin arrives in this world today. Let’s assume they are normal in all aspects. Someone decides to patch one eye of one twin and not remove it till the child is 8 years old. What do you think will happen to the eye that had the patch?

The eye that had the patch would have a very very poor vision if at all. The sad part is that there is no treatment in the world that will bring the vision back in the patched eye.  The other twin will have a completely normal vision.  Your child eye doctor/eye specialist would most likely not offer you much after the child with the patch has crossed 10 years of age.  The eye exercises for lazy eyes/eye patch for lazy eyes only work in younger children.  

This eye which now has no vision is a LAZY EYE. What this means is that the eye structure is normal but there is no vision in that eye.

In humans, the vision develops after birth until up to 7-8 years of age. If during these 7 years there is an obstruction to that development then vision will not develop in the eye.  After 7 – 8 years of age, its too late, and no matter what we do vision cannot improve.  There are, however, some reports that claim that lazy eye in adults has been treated. While these may be true, the volume of this data is not significant.

WHAT ARE AMBLYOPIA CAUSES?

Amblyopia causes could be many.  To analyze this we have to consider all those eye conditions that obstruct normal visual development.

Well, let’s say a child has a high glass power and does not wear his glasses. In that case, the eye is not seeing well. Now, the eye not seeing, is not as bad as patching an eye but bad enough. So having glasses ( of a high number) and not wearing them could be a reason to develop a lazy eye.  This is one of the commonest amblyopia causes because this condition may go undetected.

The other obstruction could be a child born with a cataract in one eye and parents deciding not to get it operated. The cataract is as bad as a patch because it is not allowing the light to enter the eye at all. In fact, your eye specialists for children operate on this young cataract at 6 weeks of age. Ophthalmology as a specialty has few emergencies and this is one of them.  This is one of the rarer amblyopia causes but the amblyopia is very severe or dense.  Which is why it needs urgent treatment.

When a child has a squint, the eye which has the squint is not used. The reason for this is that when there is a squint, the brain stops using the eye that is squinting. This of course happens only in young children and is called ‘suppression’. The reason the brain suppresses this squinting eye is so that the child does not see two of everything. In other words, the brain does not want the child to have double vision. The brain suppressing the eye is like a patch and vision in that squinting eye does not develop because of this suppression.

In the above situations, the child is not using the eye that has a cataract or squint or high numbered glasses. Thus the development of vision in that eye is not happening and the child develops amblyopia or a lazy eye.

Amblyopia causes could be many.  To analyze this we have to consider all those eye conditions that obstruct normal visual development.

Well, let’s say a child has a high glass power and does not wear his glasses. In that case, the eye is not seeing well. Now, the eye not seeing, is not as bad as patching an eye but bad enough. So having glasses ( of a high number) and not wearing them could be a reason to develop a lazy eye.  This is one of the commonest amblyopia causes because this condition may go undetected.

The other obstruction could be a child born with a cataract in one eye and parents deciding not to get it operated. The cataract is as bad as a patch because it is not allowing the light to enter the eye at all. In fact, your eye specialists for children operate on this young cataract at 6 weeks of age. Ophthalmology as a specialty has few emergencies and this is one of them.  This is one of the rarer amblyopia causes but the amblyopia is very severe or dense.  Which is why it needs urgent treatment.

When a child has a squint, the eye which has the squint is not used. The reason for this is that when there is a squint, the brain stops using the eye that is squinting. This of course happens only in young children and is called ‘suppression’. The reason the brain suppresses this squinting eye is so that the child does not see two of everything. In other words, the brain does not want the child to have double vision. The brain suppressing the eye is like a patch and vision in that squinting eye does not develop because of this suppression.

In the above situations, the child is not using the eye that has a cataract or squint or high numbered glasses. Thus the development of vision in that eye is not happening and the child develops amblyopia or a lazy eye.

AMBLYOPIA TYPES?

Amblyopia types depend on the causes of amblyopia.

  1. Anisometropic Amblyopia – Here the eye power is different in each eye and the eye with higher power may develop a lazy eye
  2. Strabismic Amblyopia – Here the child may have a squint and the squinting eye may develop amblyopia.  Strabismus is another name for squint.
  3. Vision deprivation Amblyopia – Here the child may have a cataract and this cataract has totally blocked light from entering the eye thus causing amblyopia.

HOW CAN ONE PREVENT LAZY EYE OR AMBLYOPIA?

If a child is less than 7 years and needs to wear glasses ( higher power or say more than + or – 2.0) then the child should wear them so that vision develops. Once the vision develops and the child is older than 8 years, the development of vision is set and will not change. If after that age the child does not wear glasses, the potential for good vision will not decrease. All that will happen is that whenever the child does not wear glasses he will not see clearly and when he does he will. 

Likewise, if the child has a cataract which is the amblyopia cause and the eye specialist for your child has suggested a cataract surgery, then parents should consider getting the cataract surgery as soon as possible. 

The most important step that parents can take in preventing lazy eye is to get a routine eye check-up.  Sometimes children have a lazy eye and know that they are seeing poorly with one eye compared to the other.  But, what they don’t know is that it is not normal to see like this.  Children feel that everybody around them also see just the way they see.  Also, the other eye is great and they can actually carry on with their activities quite comfortably.  So, they never complain and by the time parents realize it could be very late. 

Thus, getting a routine eye test is critical in preventing lazy eye.   In fact, lazy eye is the most important condition that school eye programs detect.  Over the past many years doctors from Eye Solutions have diagnosed many children with a lazy eye and with timely treatment, it all ends well.

LAZY EYE TREATMENT?

 

Treatment for Lazy eye or treatment for amblyopia involves lazy eye exercises or eye patch for lazy eyes. 

Eye Patch for lazy eye treatment

We will start with the commoner of the two amblyopia treatments, a lazy eye patch. When a child eye doctor sees a child with an Amblyopia he/she may advise an eye patches for lazy eye treatment.  As the name suggests these are actually patches.  Something like big band-aids.  These oval, sticky, lazy eye patches, stick on the stronger eye, or the normal eye.  With the stronger eye covered, the weaker eye has no choice but to try and see the world.  This forceful viewing develops the visual centers in the brain. Thus, the vision in the weaker eye develops.   

Now, making a child wear an eye patch for lazy eye treatment is not easy.  The child cannot see well from the uncovered eye, so obviously won’t like it.  There is also an issue of something being on the face which could be very irritating for anyone.

There are online books available with fun stories about lazy eyes and how kids wear eye patches.  The school teachers may also have to be spoken too to make sure other kids understand what’s happening.  One can even call it a pirates patch or a sibling could color on the patch as a game.  Using these coloring or drawing books is like performing eye exercises for lazy eyes so that the weaker eye gradually develops better vision.

Eye exercises for lazy eyes

Sometimes, for amblyopia treatment, the eye specialist for your child may also prescribe certain lazy eye exercises.  These eye exercises for lazy eyes are done on a machine called a synaptophore.   This machine forces both eyes to see at the same time.  It thus forces the weaker eye to function thus gradually improving vision.  As mentioned previously, even wearing eye patches for lazy eyes are like exercises for lazy eyes but usually, we refer to these machine exercises when we talk about eye lazy eyes exercises.

NEWER AMBLYOPIA TREATMENTS OR LAZY EYE TREATMENTS?

These days there is much online software available to help with lazy eye treatment.  This software is nothing but games that the children can play.  That should not be a problem in today’s world :).  These games come with certain calibrations.  Your child eye specialist would sit and explain to you, as parents, these calibrations.  One may need to adjust the intensity of the colors and change the size of the objects. That way the weaker eye can just about see different things on the screen.  As the vision improves, the color intensity and size are gradually decreased to make the weaker eye work harder.  In these exercises, the eye is not patched and both the eyes are open.

There has been a shift in recent years from patching to these computer exercises for lazy eyes.  There is a technical reason for this.  New research shows that its better to have good binocular vision rather than have good monocular vision.  With these exercises, both eyes get used to working together rather than vision developing only in one eye.  This is also known as ‘Binocular vision therapy’.

LAZY EYE TREATMENT FOR ADULTS?

Lazy eye treatment for adults is almost nonexistent.  Most eye doctors, because of training or otherwise don’t believe that lazy eye in adults cannot be treated.  

However, every so often there are reports of some new form of treatment that can treat lazy eye in adults.  These reports, as mentioned previously, are few but exist none the less.  

We believe, soon enough, there will be treatment options for treating lazy eye in adults too.  Unfortunately, though, there is not much we can talk about as regards this so far.

SURGERY FOR LAZY EYE

As mentioned previously, a lazy eye is a developmental problem.  There is nothing really wrong with the eyes.  In other words, the problem lies in the brain’s visual centers.  

Yes, a cataract may have caused a lazy eye or not wearing glasses could have caused a lazy eye but it’s not like the vision comes right back the minute you get a cataract surgery or start wearing glasses.  The vision will only come back when lazy eye treatment in the form of patches and exercises are done. 

Frequently Asked Questions

Amblyopia is commonly known as ‘lazy eye’. It describes a decrease in vision. This decrease in vision can be in one or both eyes however usually seen in one eye.

Amblyopia results from conditions that cause a blur in the image that the child sees. This blured image slows down visual development in that eye and thus the vision of that eye is poor even though on examination the eye appears completely normal.

These are the conditions that can cause amblyopia

  • Strabismus
  • Different refractive errors ( glass power) in the two eyes
  • Cataract (clouding of the lens)
  • Severe ptosis (drooping of the lid thus covering the eye)
  • Premature birth
  • Heredity (parents with amblyopia or strabismus)
  • Any disease affecting the eyes at a young age

Usually visual development occurs till the age of about 7-9 years. Thus children below 9 years of age are the highest risk of developing amblyopia. The younger the child the greater the risk.

There are various treatment options available to treat amblyopia. Your child’s eye doctor will explain to you the best option for your child depending on the type of amblyopia your child has.

Eyeglasses

Eyeglasses improve your child’s vision by helping the eyes to work together and by making the image that your child sees clear. To be effective the glasses are ideally worn the entire time while your child is awake.

Eye Patching for lazy eyes / Eye exercises

Your child may also need patching. This is nothing but occluding or patching the good eye. The eye with poor vision has no choice but to see and thus there is a chance of improvement of vision in that eye.
Eye drops
Sometimes patching may not work for your child. In that case your child eye doctor may prescribe certain eye drops. These drops, used in the good eye blur the vision of that eye. Again the weaker eye has no choice but to try and see the world.

Surgery

Surgery is a must for conditions like cataract or ptosis. These surgeries help to clear the obstruction to light entering the eye. Sometimes amblyopia may be because of strabismus or misalignment of eyes and may need to be surgically corrected.

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