Amblyopia ("Lazy Eye")
by David Hunter, MD, PhD, Chief of Ophthalmology at Children's Hospital BostonWhat is amblyopia?
Amblyopia, which is more commonly called "lazy eye", is poor sight in a normal eye. There's usually nothing wrong with the eye itself; it's just that the brain does not learn how to interpret the messages coming from that eye. Some people think "lazy eye" means a wandering or misaligned eye – this is incorrect. "Lazy eye" means that vision is poor because the brain hasn't been given a fair chance to use the eye. (Amblyopia should also not be confused with Strabismus, which is commonly known as crossed eyes, wandering eyes or floating eyes.)
If amblyopia is caught early, the eye can be trained to work normally.
Are there any symptoms?
Unfortunately not. It would be easier to diagnose if there were visible symptoms, but children can function fine using only one eye. If the healthy eye has normal vision, the problem usually goes unnoticed, and as a result, amblyopia is often not discovered until the first vision test in school or at the doctor's office.
How common is amblyopia?
As many as five percent of children are affected. It is a major cause of vision loss in childhood, yet it is almost always treatable if detected early.
When should children start being screened for amblyopia?
The American Academy of Pediatrics and American Academy of Ophthalmology recommend that a child's doctor should perform a screening for amblyopia at every well child visit.
How is amblyopia treated?
The traditional treatment is to put a patch over the better-seeing eye for many hours each day to force the brain to use the other eye. Unfortunately, many children fight the patch vigorously, so we've been working to find other treatments. Today, amblyopia is often treated by using eye drops to blur vision in the good eye. If you've ever gone to an eye doctor and had dilating drops, you know how that blurs your vision. We do the same with our amblyopia patients, using long-acting atropine eye drops. Parents simply put a drop in the good eye in the morning and that's it for the day. You don't have to worry about the child taking off or complaining about wearing a patch.
How long does treatment last?
Treatment can last six months to five years, depending on how old the child is when amblyopia is diagnosed. The earlier in life it's caught, the shorter and easier the treatment. Most children want to get out of the patching as soon as possible, whereas we can often use eye drops for years without any complaints.
What if amblyopia is not treated?
By the time a child is somewhere between 8 and 12 years, the loss of vision cannot be reversed by any treatment. It's very frustrating because amblyopia is so treatable. To think, here was a perfectly normal and healthy eye, and it will never have good vision because it was never given the proper stimulation to allow it to develop. That is why researchers are constantly working to invent new ways of identifying amblyopia earlier in a child's life so the disease can be treated more effectively.
David Hunter, MD, PhD, is the Chief of Ophthalmology at Children's Hospital Boston. He is a nationally recognized expert in the treatment of amblyopia ("lazy eye"), strabismus ("cross-eyes") and other eye diseases in children. He also treats adults with strabismus. For more information go to https://www.childrenshospital.org/eyes.
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