Amblyopia (Lazy Eye)

Amblyopia (Lazy Eye)

Why Its Important to See a Developmental Optometrist

Amblyopia affects about 1 in 30 individuals, or roughly one child in every classroom in the United States. According to the National Eye Institute, amblyopia is the most common cause of childhood visual impairment and the leading cause of one-eyed vision loss in young and middle-aged adults.

Amblyopia is often a hidden disability. A well-child care visit at the pediatrician’s office will not detect amblyopia. A comprehensive eye examination is the only way to diagnose amblyopia. It is not important that your child be able to talk and respond to tests. Developmental Optometrists are trained in tests used to evaluate infants and toddlers, which are very different from tests used for older children and adults. Sadly, amblyopia is often undetected in infants and toddlers if recommended eye exam schedules are not followed. This results in disabling vision loss which is not detected until the child enters school. Treatment at this stage is still possible, but places the child at a significant disadvantage in academics and sports compared to peers. Amblyopia always requires professional attention. Children do not “grow out of” amblyopia.

Parents should not expect their child to complain or report a difference between the two eyes. Since amblyopia is a developmental disorder, it is the only way a child has ever known and thus, “normal.” As a result, the child will not complain because they figure that is the way everyone sees.

Unlike other vision problems, many patients with amblyopia are often high achieving students because they can rely on their “good” eye. However, the hidden struggle of high achieving students is that they exert far more effort to earn good grades. Studying may take longer or the child may suffer from headaches or achy, uncomfortable eyes. Amblyopia’s effects on depth perception may affect coordination and athletic performance, or cause them to shy away from sports altogether. Self-esteem may also suffer because children often value themselves based on their performance in sports.

Ambylopia is a Brain Problem, Not an Eye Problem

Although commonly termed “lazy eye,” the true problem of amblyopia is with the brain instead of the eye. Because the brain would have to exert so much effort to marry the pictures from both eyes, it actively chooses to ignore the amblyopic eye (i.e. suppression). Although suppression is less efficient than normal development, it prevents visual confusion and allows the individual to function better given the circumstances. Like a “second string” athlete, the lack of participation causes all visual skills of the amblyopic eye to be weaker compared to the other eye. In effect, the amblyopic eye-brain connection becomes learning disabled.

Amblyopia is…

  • A neuro-developmental disorder of the visual system throughout the visual system from eye to brain.

  • A disruption of the brain’s ability to use both eyes together during early childhood.

  • The inability to see 20/20 that cannot be attributed to eye disease or the need for glasses.

  • Primarily caused by either a significant difference in power between the two eyes or a constant eye turn.

  • A deficiency of eye sight, eye focusing, eye teaming, eye tracking, depth perception, eye-hand coordination, and visual information processing.

  • An adaptation to reduce stress and visual confusion.

Amblyopia Misconceptions That Persist Today

A common misconception is that amblyopia cannot be treated after the person’s neurological system develops beyond the critical period, previously considered the age of 7. This is FALSE! Evidence-based medicine has proven that it is possible to treat amblyopia at any age due to neuroplasticity. Our optometric vision therapy programs offer much higher cure rates for amblyopia when compared to glasses and patching, without therapy. The earlier the patient receives optometric vision therapy the better and quicker improvements are seen; however, our office successfully treats patients well into adulthood.

Amblyopia was initially considered a one-eyed vision problem. As a result, “occlusion” (e.g. patching) quickly gained popularity. The thinking was cover the “good” eye to strengthen the amblyopic eye. While research has shown this method to work for eye sight, it also suggests that the improvements are significantly limited AND do not last in many cases. More recent research unequivocally shows that amblyopia is a problem of eye teamwork. Yet, many doctors have not yet embraced newer treatment methods.

Eye Patching Alone is No Longer the Standard of Care

While eye patching remains the first line of treatment for many professionals, it is an “Old School” approach. The significant limitation of patching is inherent to the treatment itself. Suppression of the amblyopic eye ONLY occurs under two-eyed (binocular) conditions; therefore, patching does not offer a more efficient alternative since it only teaches the amblyopic eye to work better when it is alone.

“Unilateral patching therapy only teaches a patient how to be a “one eyed person” since it does not address the underlying cause for the amblyopia, which is the lack of binocular (two-eyed) vision development.” ~ Dr. Dan Fortenbacher, Developmental Optometrist

Asking a patient with amblyopia to wear an eye patch several waking hours per day over the “good” eye is similar to tying your dominant hand behind your back and expecting you to do your job. Thus, it is no surprise that the visual disruption of patching almost always causes frustration and emotional outbursts by the patient.

At the Center for Vision & Learning, we utilize a more advanced “New School” therapy program based on the most current neuroscience. We emphasize communication between the two eye-brain connections to teach the brain a new, more efficient alternative to suppression. We train vision development through visually-guided activities supervised by trained therapists. Our in-office optometric vision therapy is supported by complimentary at-home exercises. This advanced approach normalizes the eye sight of the amblyopic eye, nurtures eye teamwork, and develops depth perception to create a more efficient individual.

The Center for Vision & Learning is a vision care practice specializing in developmental optometry and optometric vision therapy. We proudly serve Naples, Fort Myers, Cape Coral, and all of Southwest Florida – and beyond. If you would like to schedule a Developmental Vision Evaluation for you or someone you know, please call 239-682-0945 or click on the Request an Appointment tab above.


What is Lazy Eye (Amblyopia)?
Eyes on the Brain – a blog by Susan Barry, Ph.D., a neurobiologist and author of Fixing My Gaze, who has embarked on a mission to educate the public on the benefits of optometric vision therapy

Recommended Reading:

“Crossed & Lazy Eyes” by Vergara