Contact Lenses to treat Amblyopia

Everyone is familiar with contact lenses for the benefit of being able to see without having to wear eyeglasses. Those contact lenses compensate for the sight issue, but they don’t correct it, meaning that they don’t undo the problem. In our office, we use and prescribe Contact Lenses in a different way. We use Contact Lenses Therapeutically.

Most people who wear Contact Lenses use soft daily disposable contact lenses. The advantage of those lenses is that they reduce infections, inflammation, and other problems, plus, there is no need for contact lens solutions, so there is reduced cost and reduced involvement. Corneal and Scleral Lenses are made of Gas Permeable material. They are very comfortable and have the advantage that we can customize these lenses to whatever the individual needs. With soft lenses, we are limited to what contact lens manufacturers produce. With gas Permeable Lenses, we can make anything we want to. Gas Permeable lenses don’t dry out like soft lenses do, they last much longer, they transmit more oxygen, and are healthier overall. They do not need to be replaced with the frequency that soft lenses do.

Contact Lenses are an important part of our specialty lens practice. We use contact lenses in a different way to better serve our patient’s unique needs; keratoconus, problems after LASIK and refractive surgeries, Orthokeratology for myopia management for children and adults, etc.

We use Contact Lenses to improve vision and visual function. We see children and adults who have amblyopia (Lazy Eye). Elsewhere on our website, you can read and watch videos on the difference between Strabismus (an eye turn) and Amblyopia (lazy eye). Individuals who have amblyopia may have it unilaterally (one side) or bilaterally (both eyes).

Most people, and even most eye doctors, think of Amblyopia (lazy eye) as a one-eye problem. People are familiar with the concept of patching the “good eye” to improve the “bad” eye. The problem is that patching rarely works. Initially, there is improvement in the eye, but often that does not last long term. The individual never learns how to use the 2 eyes together. Doctors have prescribed patching for decades, and many eye doctors continue to prescribe it even though the improvements usually are limited to a few lines of acuity, and then stop. The benefits don’t continue long term. Other solutions are eyeglasses, Bangerter Foil, and Vision Therapy alone.

Amblyopia is a problem of using the 2 eyes together as a team. We use Contact Lenses to improve acuity and to speed up the Vision Therapy program in order to gain visual skills.

What are some of the parts of Vision?

1.  Sight: being able to see individual letters clearly at distance. (the eye chart that everyone is familiar with.
2.  Eye Health: to make sure that there is no eye disease in the various parts of the eye. Examples of eye health problems are Cataracts, Glaucoma, Retinal Detachment, etc.
3.  Eye Teaming: the vision-gathering portion of vision includes the ability to: converge (point the eyes in) and diverge (point the eyes straight), accommodate (physical focusing), and oculomotor skills (eye movements such as saccades to jump from one object to another, and pursuits to track across the page).
4. Visual Processing is how we make sense of what we are seeing and have gathered, and then combine it with other senses (auditory, vestibular, touch, etc) in order to create a single, unified, clear understandable perception of our world, so we can then be able to cognate (arrive at new concepts and ideas). This is somewhat like hearing someone speak a foreign language, but not being able to understand what they are saying.
5. Motor Output: how we use our visual system to then direct action and move our bodies, limbs, and muscles. It is the visual input that directs the motor output.

Seeing individual letters clearly is only the first part of the process, but it is a very important part. When someone is not able to see clearly with each eye, then the 2 eyes can’t work together as a team and the remainder of what needs to happen in order for someone to better function and be independent.

It is common to think that eyeglasses should solve all vision problems. They don’t. Eyeglasses focus light onto the back part of the eye. Vision is much more than just sight. There must be a solid connection from the eye to the brain, and then how the 2 eyes work together in order to become binocular, see in-depth, track across the page, jump from one word to the next, etc.

When someone is very hyperopic (farsighted) their eyes look magnified to others when they wear eyeglasses, and they see the world as magnified. This alters the perception of space. Contact Lenses are obviously in contact with the eye and offer the advantage of obtaining a better perception of space. They also reduce the difference in sight between the two eyes.

In our office, we use soft and gas-permeable lenses in order to obtain better overall results. We use contact lenses therapeutically rather than merely as a way to compensate for a sight issue such as myopia (nearsighted) hyperopia (farsighted), or astigmatism. Amblyopia is the reduction in vision rather than just a reduced acuity (sight).

Below are some of the risk factors that bring about Amblyopia:

1. Anisometropia - a large difference between the two eyes
2. High Bilateral Ametropia - both eyes are very farsighted or very nearsighted.
3. Esotropia - Strabismus one eye turns in relative to the other, and vision does not develop from the eye that turns in. that is called Strabismic Amblyopia.,

We have prescribed contact lenses for even very young children. It is common for parents to be taken aback to the idea of contact lenses. “How am I possibly going to be able to put them in?”.

Some examples of situations where parents do what they didn’t expect to have to do are:

1. If a child has diabetes, parents must learn how to inject insulin.
2. If a child has asthma, parents need to learn how to administer nebulizer treatment.
3. If a child has cancer, then they require even more extensive treatment.

Fortunately, most parents don’t have to deal with these types of problems, but if the condition arises, parents must do what they need to do. Fortunately, amblyopia is not a life-threatening problem and someone can live with amblyopia, however, not addressing this early means that the child will ultimately have more difficulty in school and in sports. They are likely to have difficulty driving a car.

Amblyopia affects much more than just visual acuity. It affects how the individual functions. When someone has amblyopia, there is reduced contrast sensitivity, accommodation, oculomotor skills, and overall depression of the binocular system and stereopsis. When someone has amblyopia, they are not able to use the 2 eyes together as a team to best input information and process that information.

When you come in with your child for an evaluation, we are better able to make specific recommendations as to how we will prescribe Therapeutic Contact Lenses in order to solve the amblyopia. We have had great success using this approach using contact lenses to help people treat and solve amblyopia. Often, this is done concurrently with Vision Therapy to re-educate the vision system. It is possible to do just the Therapeutic Contact lenses without Vision Therapy, or to then follow with vision Therapy at a later point.