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Amblyopia or Lazy Eye Surgery

More about kids eye problems

Amblyopia or Lazy eye is one of those conditions that your child's eye doctor or child eye specialist will treat with lazy eye exercises or eye patches for lazy eyes. Here the eye structure is totally normal but vision is poor. This poor vision is because of the poor development of the visual centres in the brain. More about that later in this text.

What Is Lazy Eye or Amblyopia meaning?

Let me start with a story. Cute twins arrive in this world and 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 eight years old. What do you think will happen to the eye that had the patch?

The eye that had the patch would have very poor vision, if at all. The sad part is that few treatments in the world will bring the vision back in the patched eye. The other twin will have completely normal vision. Your child's eye doctor/eye specialist would most likely not offer you much after the child with the patch has crossed ten years of age. The eye exercises for lazy eyes/eye patches for lazy eyes only work in younger children.  There are however, newer exercises that are now available and have been mentioned later in the article.

This eye which now has no vision is a LAZY EYE. A lazy eye thus means 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 there is an obstruction to that development during these seven years, vision will not develop in the eye. It's too late after 7 – 8 years of age, and vision cannot improve even after traditional treatments. There are, however, newer treatments available that can treat lazy eyes in adults or older children.

Amblyopia types?

Amblyopia types depend on the causes of amblyopia.

  1. Anisometropic Amblyopia – Here, each eye's eye power is different, 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, which has blocked light from entering the eye, thus causing amblyopia.

What are Amblyopia causes?

Amblyopia's causes could be many. We have to consider all those eye conditions that obstruct normal visual development to analyse this.

A child has glasses but does not wear them

Let's say a child has a high eye 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. Not wearing glasses is one of the most typical amblyopia causes because this condition may go undetected.

A child is born with a cataract

The other obstruction could be a child born with a cataract in one eye and parents deciding not to get it operated on. The cataract is as bad as a patch because it does not allow light to enter the eye. Your eye specialists for children operate on this young cataract at six weeks of age. Ophthalmology as a speciality has a few emergencies, and this is one of them. Pediatric Cataracts are rarer amblyopia causes, but amblyopia is very severe or dense, which is why it needs urgent treatment.

A child has a squint

When a child has a squint, the eye with the squint is not used to seeing things because the brain stops using the squinting eye. Of course, the brain not using the eye happens only in young children and is called 'suppression'. The brain suppresses this squinting eye 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 visual development in that eye does not happen, and the child develops amblyopia or a lazy eye.

 

How can one prevent Lazy Eye or Amblyopia?

Wear glasses if you have to

If a child is less than seven years old and needs to wear glasses ( higher power or say more than + or – 2.0), the child should wear them so that vision develops. Once the vision develops and the child is older than eight years, the development 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. 

Get operated for cataract

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

Get a routine eye examination

The most important step that parents can take to prevent lazy eyes is getting a routine eye check-up. Sometimes children have a lazy eye and know that they see 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 sees just the way they see. Also, the other eye is excellent, and they can carry on with their activities quite comfortably. So, they never complain, and by the time parents realise it could be very late. 

Encourage school eye care programs

Thus, getting a routine eye test is critical in preventing lazy eyes. In fact, a 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 eyes and with timely treatment, it all ends well.

Lazy Eye Treatment?

Treatment for Lazy eyes or amblyopia involves lazy eye exercises or eye patches for lazy eyes. 

Watch this video below of a new treatment for lazy eyes.  Our experience shows that it is very effective for all ages.

When is it too late to treat lazy eyes?

Traditionally lazy eye treatments were offered only upto 8-10 years of age. Newer form of treatments have since become available and are showing great results. Today we can treat lazy eye even in adult patients with the right exercises.

 

 

Eye Patch for Lazy Eye Treatment

We will start with the commoner of the amblyopia treatments, a lazy eye patch. When a child's eye doctor sees a child with an Amblyopia, they may advise eye patches for lazy eye treatment. As the name suggests, these are 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 centres in the brain. Thus, the vision in the weaker eye develops.   

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 irritate 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 to and make sure other kids understand. One can even call it a pirates patch or a sibling could colour it as a game. Using these colouring 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 specific lazy eye exercises. Exercises for lazy eyes are on a machine called a synaptophore.   This machine forces both eyes to see at the same time. It thus causes the weaker eye to function, thus gradually improving vision. 

Lazy Eye Treatment for Adults?

Lazy eye treatment for adults used to be almost nonexistent. Because of training or otherwise, most eye doctors don't believe that they can treat lazy eyes in adults.  

However, there are new forms of treatment that can treat lazy eyes in adults. These treatments are some or the other forms of exercise and are proving to be highly effective.

There are two treatments for adults

  1. Orthoptek 
  2. Revital vision

Newer Amblyopia Treatments or Lazy Eye Treatments?

There are a few online softwares for lazy eye treatments. These softwares could be games or certain activities that both adults and children can do. For all computer-based exercises, there are certain specifications like screen size, distance from the computer and room lighting. Your child's eye specialist would sit and explain these specifications to you as parents. One may need to adjust the intensity of the colours and change the size of the objects. 

In recent years, there has been a shift from patching to these computer exercises for lazy eyes. There is a technical reason for this. New research shows that it's 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. Exercising with both eyes open is known as 'Binocular vision therapy'.

There are two forms of treatment

  1. Orthoptek 
  2. Revital vision

Orthoptek

  • This is a clinic-based exercise.
  • The person has to look at a screen that has blinking lights.
  • Each session takes about 40 minutes. This time can increase if the amblyopia is severe. 
  • We have seen improvements in vision and stereopsis or binocular vision even after a few sessions. However, we do feel that person should do at least 10 sessions before stopping. The number of sessions needed also depends on the severity of amblyopia. 
  • We have seen very good results with this form of therapy. 
  • At Eye Solutions, we charge Rs 500 per session.
  • Watch the video to know more.

Revital Vision

  • This is a computer-based exercise sold by an American firm. This therapy has received FDA approval.
  • There is evidence to show that it is very effective.
  • Each session lasts for about 40 minutes but can be done in the comfort of your home.
  • Once you decide to do these exercises you will get a computer login and password.
  • You will have 60 sessions with one purchase. 
  • Each session is for Rs 500 which comes to Rs 30000 as an upfront payment for 60 sessions. 
  • At Eye Solutions, if we feel that the patient may need only a few more sessions to improve vision we go ahead and offer these additional sessions at no cost.

Surgery for Lazy Eye

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

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. It's only after lazy eye treatment like patches and exercises, that the vision will come back.

Vision therapy centres for children in Mumbai

There are many centres in Mumbai for vision therapy. Some are related to eye yoga. We don't believe that these help significantly. At the same time we believe that these eye yoga centres don't harm the eyes either.

At Eye Solutions we offer two types of treatments, both of which have shown excellent results. One of these is performed at the clinic and one can be done at home.

Conclusion

  • Amblyopia is a condition in which vision is poor in one or both eyes becasue of under development of the visual centres in the brain.
  • At the outset doctors should find out why the amblyopia occured and treat that condition and that could mean giving the correct glasses or operating for cataract.
  • Amblyopia is treated with eye patches on the stronger eye. Sometime some eye drops are also used.
  • Traditionally amblyopia was treated only in the young and no treatment was offered to adults. However, there are 2 new treatments that have shown promising results in adults too. Orthoptek and Revital Vision.  To know more write to us our contact us page.

Frequently Asked Questions ?

Amblyopia meaning ?
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.
What age group are at risk?
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.
What are Amblyopia Causes?
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
What is the treatment for Amblyopia?
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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