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What is Amblyopia?

Amblyopia, commonly known as lazy eye, is the eye condition noted by reduced vision not correctable by glasses or contact lenses and is not due to any eye disease. The brain, for some reason, does not fully acknowledge the images seen by the amblyopic eye. This almost always affects only one eye but may manifest with reduction of vision in both eyes. It is estimated that three percent of children under six have some form of amblyopia.

Lazy Eye and Strabismus are not the same condition.

Many people make the mistake of saying that a person who has a crossed or turned eye (strabismus) has a "lazy eye," but lazy eye (amblyopia) and strabismus are not the same condition. Some of the confusion may be due to the fact that strabismus can cause amblyopia. Amblyopia can result from a constant unilateral strabismus (i.e., either the right or left eye turns all of the time). Alternating or intermittent strabismus (an eye turn which occurs only some of the time) rarely causes amblyopia.

While a deviating eye (strabismus) may be easily spotted by the layman, amblyopia without strabismus or associated with a small deviation usually can be not noticed by either you or your pediatrician. Only an eye doctor comfortable in examining young children and infants can detect this type of amblyopia. This is why early infant and pre-school eye examinations are so necessary.

Due to misunderstanding or misuse of the terms for different visual conditions (i.e., crossed eyes vs. lazy eye), many people are inaccurately labelled as having a "lazy eye." If you think you or someone you know has lazy eye, it is recommended that you learn more about Lazy Eye and the different types of Strabismus. For example, see What is Strabismus?, Exotropia or Esotropia.

In addition, learn about a much more common visual condition which affects binocular (two-eyed) vision and is also not easily discernable to the outside viewer. This condition is also not detected by the standard 20/20 eye test

Causes of Amblyopia

Both eyes must receive clear images during the critical period. Anything that interferes with clear vision in either eye during the critical period (birth to 6 years of age) can result in amblyopia (a reduction in vision not corrected by glasses or elimination of an eye turn). The most common causes of amblyopia are constant strabismus (constant turn of one eye), anisometropia (different vision/prescriptions in each eye), and/or blockage of an eye due to trauma, lid droop, etc. If one eye sees clearly and the other sees a blur, the good eye and brain will inhibit (block, suppress, ignore) the eye with the blur. Thus, amblyopia is a neurologically active process. The inhibition process (suppression) can result in a permanent decrease in the vision in that eye that can not be corrected with glasses, lenses, or lasik surgery.

Diagnosis of Amblyopia

Since amblyopia usually occurs in one eye only, many parents and children may be unaware of the condition. Far too many parents fail to take their infants and toddlers in for an early comprehensive vision examination and many children go undiagnosed until they have their eyes examined at the eye doctor's office at a later age.

The most important diagnostic tools are the special visual acuity tests other than the standard 20/20 letter charts currently used by schools, pediatricians and eye doctors. Examination with cycloplegic drops can be necessary to detect this condition in the young.

Treatment of Amblyopia

Amblyopia can be successfully treated up to the age of 17. See a report on the latest research at National Institutes of Health -- National Eye Institute. Early treatment is usually simple, employing glasses, drops, vision therapy and/or patching. Detection and correction before the age of two offers the best chance for a cure.

According to current research, amblyopia can not be cured -- normal 20/20 stereo vision -- without early detection and treatment. However, treatment for older children and adults is usually successful in improving vision and should be attempted. Treatment of amblyopia after the age of 17 is not dependent upon age but requires more effort including vision therapy. Every amblyopic patient deserves an attempt at treatment.

Strabismus is responsive to treatments at all ages. Therefore, as explained earlier, it is important to make careful distinction between amblyopia and strabismus.

While no recent scientific studies have been done on treatment of amblyopia after the age of 17, the optometrists in our network collectively report decades of clinical success with adult amblyopia. [This editor hopes for an NEI study on adult amblyopia and neuroplasticity].

To quote one of our members, Dr. Leonard J. Press, FAAO, FCOVD: "It's been proven that a motivated adult with strabismus and/or amblyopia who works diligently at vision therapy can obtain meaningful improvement in visual function. As my patients are fond of saying: "I'm not looking for perfection; I'm looking for you to help me make it better". It's important that eye doctors don't make sweeping value judgments for patients. Rather than saying "nothing can be done", the proper advice would be: "You won't have as much improvement as you would have had at a younger age; but I'll refer you to a vision specialist who can help you if you're motivated."

In conclusion, improvements are possible at any age, but early detection and treatment offer the best outcome. If not detected and treated early in life, amblyopia can cause a permanent loss of vision with associated loss of stereopsis (two eyed depth perception). Better vision screenings are needed for young children. The 20/20 eye chart screening is not adequate.