Amblyopia: The Lazy Eye

What Is Amblyopia?
Amblyopia, sometimes called “lazy eye”, is a very common condition affecting one out of every 40 children. A lazy eye may deviate inward, outward or upward but is often almost perfectly aligned with the other eye and simply out of focus. The brain prefers the vision from the eye that is in focus or that is used most frequently. The brain receptors actually “hook up” with the better eye, thus leaving the “lazy eye” without proper input to the brain. Poor vision results in the lazy eye.

Treatment for Amblyopia
Treatment can be effective in restoring vision to an eye with amblyopia. First, if the eye with amblyopia is out of focus, glasses may be needed to maintain a clear image on the back of the eye (the retina) so the brain may receive a clear image. However, parents often mistakenly hope and dream that all their child with amblyopia will need is glasses. Very commonly, glasses alone will NOT effectively treat the amblyopia. The eye that has not been used still has a smaller number of brain receptors and must regain use of these brain receptors.

Eye Patching
Patching is the most common technique for treating children with amblyopia. However, most children will not be happy to change from using an eye that sees normally (the “good eye”) to an eye that sees poorly, sometimes extremely poorly. The central or straight-ahead vision of amblyopia eye has not been used, even though the child has been using the peripheral or side vision from the poorer-seeing eye. Thus, patching may create a real hardship or difficulty for the child who is asked to wear an eye patch to treat amblyopia.

What Can Parents Do to Make Patching Easier?
First, parents should NEVER make the mistake of beginning the patching by placing the patch on your child and sending them to school for the teacher do deal with. Your teacher’s job is primarily to teach your child; the teacher should certainly be made aware of your child’s condition, but it is almost always best not to begin patching at school.

When Should Patching Begin?
It is highly recommend that patching begin when a parent can spend some quality time with your child at the very onset of patching. Almost always, the first few hours or days of patching will be the most difficult as your child is adjusting to using one eye with poor vision AND dealing with the emotional upheaval and disorientation of an entirely new experience. The weekend is usually the best time to begin patching. Let your child perform a fun and visually stimulating activity, such as watching a favorite TV program, playing a video game or working a puzzle. Playing outside, going to the mall or participating in other outdoor activities may be somewhat difficult, particularly at first. There is nothing wrong with offering rewards for wearing the patch and some type of mild punishment for not wearing the patch. Remember, your efforts can result in a lifetime of good vision for your child as well as help keep your child’s eyes in good alignment that can have a profound effect on their self-esteem, appearance and even choice of occupation.

What Activities Are Best?
The best activities while wearing a patch are those involving the greatest visual stimulation with the greatest attention to detail. Video games by far give the most improvement in vision with the least amount of time for patching. However, any visually stimulating activity your child finds pleasurable will be helpful.

Will Patching Correct Eye Misalignment?
The main goal of patching is to improve the vision in the eye with poor vision. In most cases, an eye that deviates will continue to deviate. There are some cases in which the improved vision can result in better ocular alignment. If surgery is needed to straighten your child’s eyes, the improved vision from patching will definitely help keep your child’s eye straight after surgery.

How Long Should Patching Be Continued?
The first goal is to perform enough patching to obtain the greatest visual improvement possible, hopefully to improve vision to a normal level. The younger the child, the more likely very good vision can be obtained. Some children can wear a patch for only a few weeks and gain permanent visual improvement that lasts their entire life. However, a great many children will lose vision if the lazy eye is not patched on a part time basis for many months or years. Most children will stabilize at about age nine. Your child may not require patching until that time, but it is best to continue to have regular eye exams until at least age nine years if amblyopia has even been diagnosed. Some children with amblyopia can lose small amounts of vision even after age 9, but this can usually be prevented with regular eye exams with treatment as necessary.

Will Eye Drops Treat Amblyopia?
Sometimes eye drops that blur the vision in the “good eye” can be used to improve vision in patients with amblyopia. The eye drops, usually Atropine 1%. blur the vision at near in the normally seeing eye. The drops may also blur vision at distance is your child is slightly hyperopic (farsighted), which is a normal condition occurring in relatively few children. In some patients, Atropine eye drops can be combined with patching to improve vision. If the vision in the amblyopic eye is extremely poor, Atropine will usually be ineffective. As the vision improves, these eye drops may play a useful role.

How Late in Life Can Amblyopia Be Treated?
Amblyopia that results from a dense cloudiness of the front of the eye can only be treated in the first few months after onset of the cloudiness of the eye. Fortunately, most amblyopia results from an eye that deviates in, out or up or an eye that is out of focus. While treatment for amblyopia is much more effective when done prior to age 3 or 4 years, some children can obtain visual improvement at much later ages. If early-age treatment ineffective, treatment at an older age will generally also be unsuccessful. However, if treatment for amblyopia was never performed, teenagers can often have significant visual improvement from visual loss resulting from amlyopia. Contact lenses are often used instead of thick glasses, and patching can be done at home. These techniques have often resulted in significant visual improvement in patients that had been resigned to poor vision in one eye forever.

The Importance of Patching
Patching to treat amblyopia can be difficult at times but the ultimate goal should be kept in mind: you are giving your child a remarkable gift, the ability to have good vision in both eyes that can last a lifetime. This improvement can result in straighter eyes, a wider choice of occupations and a lesser risk of bilateral blindness should disease or injury occurs to what would have been the only eye with good vision.