What is Amblyopia?

Amblyopia, commonly referred to as “lazy eye” is when there is a significant difference in power between the eyes. This is often, but not always, caused by an alignment or eye-teaming problem such as strabismus.

Some common symptoms and problems associated with lazy eye:

• Poor depth perception
• Head tilting
• Social stigma
• Slow reading*

*According to a study published on November 2015 by the Journal of the American Association for Pediatric Ophthalmology and Strabismus, children with amblyopia read slower 42 words per minute than children without amblyopia that read 81 words per minute.

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Treatment for Amblyopia: It’s Not about the “Bad” Eye

Amblyopia or “lazy eye” is best treated by Vision Therapy.

First, the source of the amblyopia must be identified. When indicated, eyeglasses are prescribed. Many eye doctors, particularly Pediatric Ophthalmologists, begin treatment by patching the "bad" eye. However, patching is now proven to be ineffective! Likewise, some doctors recommend atropine eye drops. However, this addresses the symptoms and not the neuro-optometric cause itself.

The common approach treats the problem as a problem in that one eye. Treating one eye may improve the acuity (being able to see letters on a chart) for a while, but often reverts and regresses.

The developmental approach taken by Vision Therapists realizes that amblyopia is really not an eye problem, but rather a problem of not being able to use the two eyes together as a team (eye-teaming). This approach is therefore often much more successful. In the same way that it was difficult for a parent to identify if someone had the problem, to begin with, it is often difficult for them to know if a doctor's recommendation to patch the eye is really working. They, therefore, may be losing time with an ineffective outdated treatment plan.

Amblyopia does not go away on its own, and it can significantly affect a child’s ability to both learn and thrive socially in school. Untreated amblyopia can lead to permanent visual problems and poor depth perception. To prevent this and to give your child the best vision possible, amblyopia should be treated early by vision therapy.

At What age Can Vision Therapy Treat Amblyopia?

An old axiom that is still held by many [location] eye doctors is that amblyopia must be detected and aggressively treated before the age of 8 or 9. In reality, treatment for  amblyopia or lazy eye is effective for adults as well as children. A child’s visual system is more malleable at a younger age, making treatment quicker at a younger age. However, adults with amblyopia or “lazy eye” tend to be more motivated patients. Improved eye teaming is nearly always achievable.

What is Strabismus?

Strabismus, often referred to as “Crossed Eyes”, “Wandering Eyes”, or “Wall Eye” is a condition where the eyes fail to properly align. Beyond the social stigma, strabismus often results in other vision and visual processing problems such as diplopia (double-vision), amblyopia, and problems with depth perception. A major concern for developmental optometrists is that strabismus is not as simple to diagnose as a visual check. In fact, you can have strabismus without any obvious crossing or eye turn.

There are four kinds of strabismus, two horizontal and two vertical:

• Esotropia:     one eye may turn in relative to the other {try and find images for these, commons domain}
• Exotropia:    one eye turns out relative to the other
• Hypertropia:  one eye turns up relative to the other
• Hypotropia:   one eye turns up relative to the other

Treatment for Strabismus

All too often, parents are told "don't worry, your child will 'grow out of it'. This is a mistake. In most cases the problem does not improve as the child grows, and meanwhile strabismus leads to significant difficulties with reading and learning. Treatment varies depending on the cause of the eye-turning, and may include:

• Eyeglasses
• Vision Therapy
• Prism
• Eye muscle surgery

Eye muscle surgery can sometimes make the eyes appear to others as if it is straight, but it rarely aligns with the other eye, and the amblyopia continues.  A program of Vision Therapy for children or adults, is usually needed in order to restore visual function and the ability to use the two eyes together as a team.

What is Convergence Insufficiency?

Convergence Insufficiency is a neuro-visual condition where the eyes fail to come together (to converge) enough to enable proper visual perception. The condition is particularly related to near-vision or near-center and visually demanding activities. This can result in:

• Poor school performance and behavioural problems
• Eyestrain
• Blurred vision
• Diplopia (double-vision)
• Asthenopia (eye strain and fatigue)
• Difficulty making eye contact
• Fatigue
• Headaches and migraines
• Difficulty reading and concentrating
• Avoidance of “near” work
• Poor sports performance
• Dizziness or motion sickness

A study of almost 700 5th and 6th graders indicated that convergence insufficiency is much more common than many assumed with 13% of students having CI, as well as demonstrating that of the children who showed three signs of CI, 79% where classified as being accommodative insufficient as well.

Treatment for Convergence Insufficiency

Eye coordination problems such as convergence insufficiency and convergence excess generally cannot be improved with eye glasses or surgery. Likewise, research demonstrates that the traditional focus exercise often called "pencil pushups" are ineffective. The only consistently effective treatment for convergence insufficiency is office-based Vision Therapy, which will improve eye coordination abilities and reduce symptoms and discomfort when doing close work.