Lazy eye / Amblyopia therapy
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Definition: When a child has poor vision in one or both eyes due to the uncorrected refractive error or squint or due to the inability of the light to reach the interior of the eye, it is called Lazy eye or Amblyopia.
Silent killer of vision: The child will never complain and it can affect vision permanently
Causes: Squint/ uncorrected refractive errors/ lid drooping/ cataract/ corneal opacity
Left eye --> lazy eye
Treatment: Patching or Occlusion therapy of the better eye (right eye) facilitates improvement in the Vision in the Lazy eye
Treatment: Dichoptic therapy for Amblyopia management
- Lazy eye is the commonest cause of monocular blindness in the age group 20-50 years in USA
- Lazy eye is associated with loss of binocular vision or fusion (in-ability to use two eyes together) in children and adults
- Lazy eye is associated with loss of stereopsis (3 dimensional vision)
- Lazy eye is associated with the squint or crossed eyes
All of these increase the chances of injuries and accidents in life, reduced eye hand coordination, increased dependent years in life and reduced motor skills.
Treatment: of lazy eye begins with an early detection. It depends on the cause. Most often patching of the stronger eye is necessary
The latest treatment with eye patching and eye exercises at the earliest age offer the best chances for maximum improvement in children with lazy eyes.
Research has shown that conventional treatment of lazy eye can be successful in a low minority at older age. (success rate in amblyopia treatment studies reveal 47% success in age between 7-12 years and 25% success between 12-17 years)
This condition can be treated with
- Patching/occlusion therapy
- Penalization/pharmacological (oral levodopa) methods
- Dichoptic therapy
- Oral medicines
The results of lay eye treatment or lazy eye exercises can be very satisfying, provided it is diagnosed in time and appropriately treated.
Patching / Occlusion
- Patching /Occlusion is the most recommended form of treatment as it is safe and effective.
- It involves covering the good eye with an eye patch, forcing the lazy eye to work harder.
- Research has shown, allowing children to perform fine activities like drawing, coloring ,and playing games on mobile gives further impetus to improvement in vision.
- The duration of treatment depends on improvement in visual acuity shown on follow up visit.
- This treatment is advised for patients who are non compliant to patching.
- An Atropine eye drop (cycloplegic eye drop) is used to temporarily paralyze the accommodative action of the eye and dilate pupils. The effect gradually weans off in 3 weeks time.
- Patients have to put Atropine drop in good eye on every Friday and Saturday, hence called weekend Atropine.
- Atropine drop temporarily induces blurr in the eye.
- Research shows Penalization being as effective as patching / occlusion for improvement in visual acuity.
- Newer technologies using principles of perceptual learning, dichoptic training in the form of video games, virtual reality, occu-pad/occu-tab, are constantly being researched
- They are being tried to improve compliance in amblyopia therapy and improve results in older children, young adults as well as those in whom standard patching regimens have failed.