Amblyopia, commonly known as ‘lazy eye,’ is a neuro-developmental vision condition that begins in early childhood.
One kind of lazy eye develops when one eye is unable to achieve normal visual acuity, causing the affected eye not to see clearly, even when wearing glasses. When this is left untreated, amblyopia leads to permanent vision loss in one eye.
It’s important to understand that a lazy eye isn’t actually lazy. Usually it occurs because there is a large difference in prescription between the two eyes, so the brain ignores the visual signals from that side and doesn’t process that information. The communication on that side then deteriorates further, and this usually leads to permanently reduced vision in that eye. Fortunately, Vision Therapy can improve the condition by training the brain to work with both eyes equally.
What Causes Lazy Eye?
When the neural connections between the eyes and the brain are healthy, each eye sends a visual signal to the brain. The brain combines these two signals into one clear image, enabling us to see what we are looking at.
When someone has amblyopia, the brain doesn’t recognize the weaker eye’s signals. Instead, it relies only on the visual input from just the other eye. The child assumes this is normal and is not aware of this, so they don’t complain.
The two most common reasons for Amblyopia are: Strabismus (when an eye turns in or out), and Anisometropia (when there is a large difference between the two eyes).
Strabismus
Strabismus means that the eyes don’t line up with one another. One might point in or out relative to the other. This can occur some of the time or all of the time. We use the terms “constant” or “intermittent”. The child may alternate; meaning that at some time, the child uses one to fixate and then the other eyes to fixate.
When the eyes don’t line up, and they point in different directions, then the brain receives two images and it can’t combine the two into one single, clear image. So when the two eyes don’t line up properly, the brain cannot process the two images, so it ‘turns off’ one of the images. That side gets ignored and the wiring between the eye and the brain does not develop. The eye is healthy, but the information from the eye to the brain gets shut off. This protects the child from getting 2 confusing pictures which would cause double vision.
As the brain ‘turns off’ the weaker eye, this eye will eventually become ‘lazy’—unless we treat the problem.
Anisometropia – one form of Refractive Amblyopia
Anisometropia is when the refractive powers (visual acuity) of the two eyes are very different from one another. This causes a conflict for the brain. It causes the visual signal from one eye to be much clearer than the other. The brain then can’t make the two images work together. The brain uses only the visual signal from the eye that is sending the clearer image and begins to ignore the information from the eye with the blurrier image. This further weakens the eye-brain connection from that side. If not treated, this results in permanent poor vision in that eye.
Bilateral Amblyopia – another form of Refractive Amblyopia
Bilateral Amblyopia is when the refractive power of BOTH eyes are very high, usually when someone is very FARsighted in BOTH eyes, but it can occur in people that are highly NEARsighted in both eyes. In this case, BOTH eyes do not develop a good connection to the brain.
Deprivation
If something doesn’t allow light to reach the back part of the eye, the retina, then the wiring between the eye and the brain doesn’t develop. We actually don’t see in the eye; rather, we see in the brain. Can you “picture” yourself at home? Can you “see” yourself at the beach or on your vacation? Those are examples of how we Visualize, and actually see in the brain, not in the eye.
Deprivation Amblyopia means that light was blocked from reaching the retina the back of the eye. That can be caused by a cataract, a cloudy cornea, or a tumor of the eyelid. Each of these can affect a child’s vision, resulting in amblyopia. Sometimes these are hard to notice and that is why a child should have a full examination and not just a screening at school or at the pediatrician’s office. When identified, we can treat the problem swiftly.
How To Treat Amblyopia
The goal of most amblyopia treatments is to 1st strengthen the signal to the eye that has been neglected, and then 2ndl, to learn how to use the two together as a team. Once we do that, amblyopia is cured. Patching does not cure this long term, although many doctors practice this “old thinking”. You see, amblyopia is more of a brain issue than an eye issue.
Common ways we treat amblypia are:
- Special Eyeglasses
- Vision Therapy
- Special Contact Lenses
- Special Foils or Prisms placed on eyeglasses
- Special Eye Drop Therapy
- Patching- often recommended by some eye doctors, but this does not treat or cure amblyopia long term
Vision Therapy
Vision Therapy is the most effective treatment for amblyopia. It is often used along with other treatments.
A Vision Therapy program is customized to the specific needs of the patient. It may include the use of lenses, prisms, filters, occluders, and other specialized equipment designed to actively make the lazy eye work to develop stronger communication between the eye and the brain. Ultimately, the goal is not only for the eye to see better, but for the patient to be able to use their two eyes together as a team. Once the patient achieves that, the problem is cured and does not return. Some eye doctors still recommend patching alone, but this often does not resolve the problem and the problem then returns.
Vision Therapy is extremely effective and successful to achieve the ability to use the two eyes together as a team. That is called binocular vision. This improves visual acuity, visual processing abilities, depth perception and reading fluency.
Vision Therapy programs for amblyopia include procedures that improve the following visual skills:
- Accommodation (focusing)
- Binocular vision (the eyes working together)
- Fixation (visual gaze)
- Pursuits (eye-tracking)
- Saccades (eye jumps)
- Spatial skills (eye-hand coordination)
- Stereopsis (3-D vision)
Call our office and schedule an appointment. Discover how Vision Therapy can help improve your child’s vision. Our doctors will ask about your child’s vision history, conduct a thorough evaluation, and take your child on the path to effective and lasting treatment.
Frequently Asked Questions with Dr. Moshe Roth
Q: How do I know if my child has lazy eye?
- A: It’s difficult to identify lazy eye (Amblyopia) on your own. Even patient that have strabismus is not obvious to parents. Children generally learn how to ignore the side that is not working as well and that side does not develop the connection between the eye and the brain. Some symptoms of lazy eye include:
- Closing one eye or squinting
- Difficulty with fine eye movements
- Poor depth perception
- Poor eye-hand coordination
- Reduced reading speed and comprehension
- Rubbing eyes often
Q: How is lazy eye diagnosed?
- A: Our doctors will conduct specific tests during your child’s eye examination to assess the visual acuity, depth perception and visual skills of each eye.
Amblyopia, commonly known as ‘lazy eye,’ is a neuro-developmental vision condition that begins in early childhood, usually before the age of 8.
One form of lazy eye develops when one eye is unable to achieve normal visual acuity, causing blurry vision in the affected eye, even when wearing glasses. Left untreated, amblyopia leads to permanent vision loss in one eye.
It’s important to understand that a lazy eye isn’t actually lazy. Usually it is because there is a large difference in prescription between the two eyes, so the brain ignores the visual signals from that side and doesn’t process that information. Eventually, the communication on that side deteriorates further, and this usually leads to permanently reduced vision in that eye. Fortunately, Vision Therapy can improve the condition by training the brain to work with both eyes equally.
What Causes Lazy Eye?
When the neural connections between the eyes and the brain are healthy, each eye sends a visual signal to the brain. The brain combines these two signals into one clear image, enabling us to see what we are looking at.
In the case of amblyopia, the brain doesn’t recognize the weaker eye’s signals. Instead, it relies only on the visual input from the stronger eye.
Amblyopia can be caused by strabismus, anisometropia and deprivation.
Strabismus
Strabismus occurs when the eyes are misaligned and point in different directions. The most common cause of amblyopia is eye misalignment, which causes the brain to receive two images that cannot be combined into one single, clear image.
A child’s developing brain cannot process images when both eyes are not aligned in the same direction, so it ‘turns off’ the images sent by the weaker eye. This is the brain’s defense mechanism against confusion and double vision.
As the brain ‘turns off’ the weaker eye, this eye will eventually become ‘lazy’—unless treatment is provided.
Anisometropia – one form of Refractive Amblyopia
Anisometropia is when the refractive powers (visual acuity) of your eyes differ markedly, causing your eyes to focus unevenly – rendering the visual signal from one eye to be much clearer than the other. The brain is unable to reconcile the different images each eye sends and chooses to process the visual signal from the eye sending the clearer image. The brain begins to overlook the eye sending the blurrier image, further weakening the eye-brain connection of the weaker eye. If not treated, this results in permanent poor vision in that eye.
Bilateral Amblyopia – another form of Refractive Amblyopia
Bilateral Amblyopia is when the refractive power of BOTH eyes are very high, usually when someone is very FARsighted, but it can occur in people that are highly NEARsighted in both eyes. In this case, BOTH eyes do not develop a good connection to the brain.
Deprivation
Deprivation refers to a blockage or cloudiness of the eye. When an eye becomes cloudy, it directly impacts the eyes’ ability to send a clear image to the retina, harming the child’s ability to see images clearly from that eye. When clear images can’t reach the retina, it causes poor vision in that eye, resulting in amblyopia. Deprivation is by far the most serious kind of amblyopia, but it is also incredibly rare.
There are several types of deprivation: cataracts, cloudy corneas, cloudy lenses and eyelid tumors. Each of these can affect a child’s vision, resulting in amblyopia. Because these are also difficult to notice from a child’s behavior, it’s crucial to have your child tested for eye-related problems so that treatment can begin right away.
How To Treat Amblyopia
The goal of most amblyopia treatments is to naturally strengthen the weaker eye so that your child’s eyes can work and team with the brain more effectively. Amblyopia treatment will be determined by the cause and severity of their condition.
Common types of treatment include:
- Special Eyeglasses
- Vision Therapy
- Special Contact Lenses
- Special Filters and Prisms
- Special Eye Drop Therapy
- Patching- often recommended by some eye doctors, but does not treat or cure amblyopia long term
Vision Therapy
Vision Therapy is the most effective treatment for amblyopia, and is often combined with other treatments.
A Vision Therapy program is customized to the specific needs of the patient. It may include the use of lenses, prisms, filters, occluders, and other specialized equipment designed to actively make the lazy eye work to develop stronger communication between the eye and the brain.
Vision Therapy is highly successful for the improvement of binocular vision, visual acuity, visual processing abilities, depth perception and reading fluency.
Vision therapy programs for amblyopia may include eye exercises to improve these visual skills:
- Accommodation (focusing)
- Binocular vision (the eyes working together)
- Fixation (visual gaze)
- Pursuits (eye-tracking)
- Saccades (eye jumps)
- Spatial skills (eye-hand coordination)
- Stereopsis (3-D vision)
Contact Family Eye Care to make an appointment and discover how vision therapy can help improve your child’s vision. Our eye doctor will ask about your child’s vision history, conduct a thorough evaluation, and take your child on the path to effective and lasting treatment.
Frequently Asked Questions with Dr. Moshe Roth
- A: It’s difficult to recognize lazy eye because the condition usually develops in one eye, and may not present with a noticeable eye turn. As such, children generally learn how to ignore the lazy eye and compensate by mainly relying on the sight from the ‘good’ eye. Some symptoms of lazy eye include:
- – Closing one eye or squinting
– Difficulty with fine eye movements
– Poor depth perception
– Poor eye-hand coordination
– Reduced reading speed and comprehension
– Rubbing eyes often
- A: Your child’s eye doctor will conduct specific tests during their eye exam, to assess the visual acuity, depth perception and visual skills of each eye.
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Difficulty with fine eye movements
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Poor eye-hand coordination
Reduced reading speed and comprehension
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Family Eye Care serves patients from Old Bridge, East Brunswick, Woodbridge, and Edison, all throughout New Jersey.
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