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  • Writer's pictureCarina Lee

What Is Lazy Eye?

Dr. Carina Lee, March 28, 2022


Amblyopia, also referred to as "lazy eye," is a neuro-developmental vision disorder that usually manifests before the age of eight.


When one eye cannot reach normal visual acuity, lazy eye develops, resulting in hazy vision in the affected eye even with corrective eyewear. Additionally, reading difficulties and impaired depth perception are frequent symptoms of the illness.


Up to 1 in 33 of the population, or up to 10 million people in the United States, may be affected by amblyopia, according to study.


Amblyopia, which can impair vision in up to 3% of people, is the most common neuro-developmental vision disorder. A lazy eye can appear later in life, however it usually first manifests in early childhood.


What causes amblyopia?


When the neuronal connections between the brain and the lazy eye are compromised, amblyopia is identified. The eye delivers visual data to the brain for interpretation, and the brain sends signals back to the eye to permit clear vision. A healthy eye-brain connection can be compared to a multi-lane motorway. Amblyopia, however, prevents the "highway" from functioning as a multi-lane road because of a disruption in the visual pathways. As a result, the relationship between the brain and the lazy eye may resemble a one-lane street or even a walking track.


Is there a critical period in amblyopia?


Beginning at birth and lasting until about age six, the "critical" period for visual development is characterized by the rapid maturation of the nerves that connect the brain and eyes. Anything that disrupts this new innervation during this phase can result in a lazy eye because it prevents the simultaneous use of both eyes (binocular vision), which can result in total suppression of one eye.


Risk factors

Factors associated with increased risk of lazy eye include:

  • Premature birth

  • Small birth weight

  • Family history of lazy eye

  • Developmental delays

Vision conditions that may cause lazy eye


The most typical type of amblyopia is refractive amblyopia. It falls into two categories:

  • Isoametropia is an optical prescription that is equally high in both eyes.

  • Anisometropia is a condition in which the two eyes have a markedly different prescription for eyeglasses (e.g., nearsightedness, farsightedness, or astigmatism).

A perceptible turning of one eye in any direction over time is known as persistent strabismus. The most frequent is an inward bend of the eye (esotropia). Strabismus-related amblyopia may be simpler to identify because the obvious eye turn signals a vision issue.

Ocular obstruction may be the result of any physical obstacle to vision, including a cataract, injury, ptosis (lid droop), or clogged tear ducts.


Lazy eye can also be caused by vitamin A deficiency and less frequently by congenital conditions.

The aforementioned circumstances can lead to the development of lazy eyes, but the fundamental underlying cause of sleepy eyes is a brain reaction known as suppression. To prevent hazy or double vision, suppression happens when the brain willfully ignores all of the visual information coming from one eye (diplopia). Suppression can have detrimental effects and result in strabismus, or an eye turn.


Symptoms of lazy eye


Because the ailment typically affects one eye and may not initially show an obvious eye tilt, parents and kids frequently struggle to identify lazy eyes. Additionally, kids learn to ignore their lazy eye and use their other eye to make up for it.


Therefore, it's crucial to arrange an eye test if you experience any of the following symptoms or signs:

  • Shutting one eye or squinting

  • Rubbing eyes often

  • Poor eye-hand coordination

  • Tripping often or accident prone

  • Poor depth perception

  • Difficulty with fine eye movements

  • Reduced reading speed and comprehension

  • Poor eye focusing skills, or inability to follow an object with just the eyes

  • A cross-eyed appearance

  • Unusual eye movements such as flickering or blinking

How is lazy eye diagnosed?


All newborns and preschoolers should have thorough eye exams to ensure normal visual development and rule out any ocular disorders. A regular eye checkup for your child is also essential if there is a family history of lazy eye because the condition can be inherited.


During eye exams, certain tests are done to evaluate each eye's visual abilities and acuity, allowing your doctor to identify conditions like lazy eye.


Your doctor can evaluate the performance of each eye separately and pinpoint a strong eye-brain connection using visual skills tests. Be aware that dilating eye drops may be used by your doctor to dilate your child's pupils during the examination in order to provide a better view of the inner ocular structures. These eye drops may sting briefly and possibly obscure your child's eyesight. The drops are painful, but they work incredibly well at identifying the presence of significant eye disorders like lazy eye.


Vision therapy for lazy eye


Amblyopia can be effectively treated with vision therapy. By retraining the visual system, vision treatment has been demonstrated to significantly improve the lazy eye's visual abilities.


To obtain clear and comfortable binocular vision, the two eyes will be trained to function together through vision therapy.


Programs for visual therapy to cure amblyopia might include:

  • Accommodation (focusing)

  • Fixation (visual gaze)

  • Saccades (switching eye focus, “eye jumps”)

  • Pursuits (eye-tracking)

  • Spatial skills (eye-hand coordination)

  • Stereopsis (3-D vision)

The long-held belief that full-time eye patching and daily atropine drop administration are the most effective treatments for lazy eye has been debunked by recent Pediatric Eye Disease Investigator Group (PEDIG) study.


This study found that active vision therapy combined with intermittent patching was just as effective as continuous patching. Patient compliance and treatment satisfaction have undergone a revolution thanks to this study.


Is vision therapy effective for adults with lazy eye?


A lazy eye can actually be treated at any age, even into adulthood, as recent research have revealed that neuronal pathways in the brain can be strengthened at any age. Adult vision therapy can be quite effective, although it may take longer to see the best outcomes. Of course, the prognosis is typically better the earlier the illness is diagnosed.


The final step towards success


If your child is identified as having lazy eye, your eye doctor will probably suggest a specialized vision therapy program, either with or without eye patches or atropine drops.


Lazy eye syndrome can be effectively treated with vision therapy, and it can also help you develop the visual abilities needed for binocular vision.

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