What is Amblyopia?

Amblyopia or Lazy Eye is reduced vision in an eye despite the eye being physically normal. It sets in during early childhood.

Dr. parul sharma

Retinoscopy to find Spectacle Power in 6 month old child

What causes Amblyopia?

Amblyopia has many causes. Most often it results from either a misalignment of a child's eyes, such as squinting eyes, or one eye focusing worse than the other due to undetected spectacle power. In both cases, one eye becomes stronger, suppressing the image of the other eye. If this condition persists, the weaker eye may remain like that for lifetime.

Amblyopia normally only affects one Eye, but it is possible to be Amblyopic in both Eyes if both are similarly deprived of a good, clear visual image.

Amblyopia is a developmental problem in the brain, not an organic problem in the Eye. The part of the brain corresponding to the visual system from the affected Eye is not stimulated properly, and develops abnormally. This has been confirmed via direct brain examination.

Dr. parul sharma

Vision Assessment in 2year old

What are the different types of Amblyopia?
  • Refractive or anisometropic Amblyopia
    Refractive Amblyopia may result from anisometropia (unequal refractive errors between the two Eyes). Anisometropia exists when there is a difference in the refraction between the two eyes. The eye with less far-sighted (hyperopic) refractive error provides the brain with a clearer image, and is favored by the brain. Refractive Amblyopia is usually less severe than strabismic Amblyopia. Pure refractive Amblyopia is treated by correcting the refractive error early with prescription lenses. Vision therapy and/or eye patching can also be used to develop and/or improve Visual Abilities, Binocular Vision, Depth Perception, etc.
  • Meridional Amblyopia
    It is a mild condition in which lines are seen less clearly at some orientations than others after full refractive correction. An individual who had an astigmatism at a young age that was not corrected by glasses will later have astigmatism that cannot be optically corrected
  • Form-deprivation and occlusion Amblyopia
    Form-deprivation Amblyopia (Amblyopia ex anopsia) results when the ocular media become opaque, such as is the case with cataracts or corneal opacities.These prevent adequate sensory input from reaching the eye, and therefore disrupt visual development. If not treated in time, Amblyopia may persist even after the cause of the opacity is removed. Sometimes, drooping of the eyelid (ptosis) or some other problem causes the upper eyelid to physically occlude a child's vision, which may cause Amblyopia quickly
Dr. parul sharma

Children with Squint May have Lazy Eye

Can anything be done to treat Amblyopia and prevent Vision Loss?

With early diagnosis and treatment, the sight in the "lazy eye" can be restored or improved.

Dr. parul sharma

Occlusion Therapy

Will glasses help a child with Amblyopia to see better?

Maybe, but they may not correct it all the way to 6/6. With Amblyopia, the brain is “used to” seeing a blurry image and it cannot interpret the clear image that the glasses produce. With time, however, the brain may “relearn” how to see and the vision may increase. Remember, glasses alone do not increase the vision all the way to 6/6, as the brain is used to seeing blurry with that eye. For that reason, the normal eye is treated (with patching or Eye drops) to make the amblyopic (weak) Eye stronger.

Dr. parul sharma

Synaptophore-Orthoptic Exercises

What can be done if my child has equal high amounts of farsightedness and/or astigmatism and is diagnosed with Bilateral Amblyopia?

Bilateral Amblyopia is usually treated with consistent, early glasses, and or contact lenses with follow-up over a long period of time. If asymmetric Amblyopia (one Eye better than the other) occurs, then patching or Eye Drops may be added.

Dr. parul sharma

Amblyopia Gatch in Glasses

When should treatment for Amblyopia begin?

The earlier the treatment, the better the opportunity to reverse the Vision Loss. Although the best outcome is achieved if treatment is started before age 5, research has shown that children older than age 10 can show improvement in the affected Eye.

What treatments are available?

Before treating Amblyopia, it may be necessary to first treat the underlying cause. Glasses are commonly prescribed to improve focusing or misalignment of the Eyes. Squint Surgery may be performed on the Eye Muscles to straighten the Eyes if non-surgical means are unsuccessful. Surgery can help in the treatment of Amblyopia by allowing the Eyes to work together better. Eye exercises may be recommended either before or after surgery to correct faulty visual habits associated with strabismus and to teach comfortable use of the Eyes.

What treatment follows the correction of the underlying cause?

The correction may be followed by:

  • patching or covering one Eye may be required for a period of time ranging from a few weeks to as long as a year. The better-seeing eye is patched, forcing the "Lazy" one to work, thereby strengthening its vision.
    One should also be wary of over-patching or over-penalizing the good eye when treating for Amblyopia, as this can create so-called "Reverse Amblyopia" in the other Eye.
  • Medication- in the form of Eye Drops or Ointment—May be used to blur the Vision of the good eye in order to force the weaker one to work. This is generally a less successful approach.
    The treatment for Amblyopia requires lot of effort and patience from both the Doctors and Parents. Both have to work as a team to achieve the desired results.
How many hours per day patching is enough when treating Amblyopia?

The mainstay of treating Amblyopia is patching of the dominant (good) Eye, either full or part-time during waking hours. The performance of near activities (Reading, Coloring, hand-held computer games) during treatment may be more stimulating to the brain and produce better or more rapid recovery of vision.

How long does Amblyopia patching therapy take to work?

Although vision improvement frequently occurs within weeks of beginning patching treatment, optimal results often take many months. Once vision has been improved, part-time (maintenance) patching or periodic use of atropine Eyedrops may be required to keep the vision from slipping or deteriorating. This maintenance treatment may be advisable for several months to years.

What if my child refuses to wear the patch?

Many children will resist wearing a patch at first. Successful patching may require persistence and plenty of encouragement from family members, neighbors, teachers, etc. Children will often throw a temper-tantrum, but then they eventually learn not to remove the patch. Another way to help is to provide a reward to the child for keeping the patch on for the prescribed time period.

What are appropriate goals of Amblyopia Treatment?

In all cases, the goal is to achieve best possible vision in each eye. While not every child can be improved to 6/6, most can obtain a substantial improvement in vision. By and large, the final visual outcome is established at 3 to 4 months.

What happens if Amblyopia Treatment does not work?

In some cases, treatment for Amblyopia may not succeed in substantially improving vision. It is hard to decide to stop treatment, but sometimes it is best for both the child and the family. Children who have Amblyopia in one eye and good vision only in their other eye can wear safety glasses and sports goggles to protect the normal eye from injury. As long as the good eye stays healthy, these children function normally in most aspects of society.

Do the alternative Medicines and Techniques cure Refractory Amblyopia?

There are many websites and clinics which claim to treat Amblyopia by alternative Medicines or Techniques. Lot of unscientific techniques are being practiced all over the world. Anxious parents approach them in hope. I personally do not discourage the parents from these, as long as the technique is not harming the Eyes. I have yet to witness any case till date which improved by these methods.