How to Fix Lazy Eye?


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Evidence Based - Facts Checked

This content is medically reviewed by Dr. Udbhav Dorwal and written by Dr. Sandhya Shenoy

Last Medical Review Date - 16th November 2020


Fixing lazy eye can be successful if started early in life. During childhood, the brain is still in the developing stage and treatment done for lazy eye during this period is well accepted by the brain.

The probability of the success of treatment decreases as the individual ages. In adults who have attained full brain growth, the brain will resist the treatment if they are subjected to treatment during this stage.

However, new studies have shown that some adult individuals respond to the treatment given for lazy eye; however full recovery is still doubtful1Blair, K. (2020, August 10). 'Amblyopia'  Source.


In this article..


What are the treatment options Available For Fixing Lazy Eye?


Step 1

The first step includes correcting the underlying disease-causing Lazy Eye (Amblyopia). Following are some of the ways to treat the underlying disease-causing lazy eye:-

- Glass correction if any, for treating refractive index

- Cataract surgery and Intraocular implantation

- Squint correction- either surgical or with the help of orthoptic

- Surgical correction of droopy eyelids

- Any other pathology, which is affecting the vision, should be promptly treated.



Step 2

The second step includes treating Lazy Eye (Amblyopia).

Once the underlying medical condition in the eye is treated, your ophthalmologist shall thereafter focus on treating Lazy Eye (Amblyopia). The treatment is done by blocking the good eye and forcing the lazy eye to read. 


The good eye is blocked using patches2Chen Y;He Z;Mao Y;Chen H;Zhou J;Hess RF;. (2020, January). 'Patching and Suppression in Amblyopia: One Mechanism or Two?' Source or atropine eye drops. The treatment intends to force the weak eye to go through routine activities. The blocking of the eye shall be recommended for  a few hours to even full-day (depending on your ophthalmologist’s discretion and severity of the condition).

How Does Blocking Of Good Eye Help in Treating Lazy Eye?

When the strong impulses from the good eye are blocked, the brain is forced to accept the weak impulses coming from the lazy eye, as these are the only impulses available for the brain’s stimulus centers after blocking the good eye.

How Long Does it Take to Treat Lazy Eye?

It may take a few weeks to a few months for the lazy eye’s vision to improve. The treatment’s success requires utmost determination and dedication, not only from the child but also from the parents.

A regular visit to the ophthalmologist is necessary to monitor the improvement in the Lazy Eye (Amblyopia) and see if the good eye which is covered doesn’t develop Lazy Eye (Amblyopia).


What is the Correct Way to Patch the Good Eye For the Treatment of Lazy Eye Especially in Children?

Patching of the good eye should be done in such a way that the child should not be able to peep through the edges of the patch. It is done either by using skin patches or by covering the spectacle’s glasses using a filter.

It’s better to use skin patches in toddlers as it will seal the whole eye, like a plaster.


Patch on Eye for treatment of Lazy Eye

Skin Patch - Image Source

Patch on Eye

Filters taped onto Spectacle Glasses - Image Source

In older kids, where compliance with patch use may not be an issue, filters can be taped onto the spectacles’ glasses to cover the good eye and force the lazy eye to do the work and send the stimulus to the brain.

Quick Note - Patching, especially the plaster, can cause allergic skin reactions and is cosmetically unappealing. 

Toddlers do not like their good eye patched as it affects the vision and makes them uncomfortable. Therefore, there are high chances that they will attempt to cheat by removing the patch or peep through the patch’s edges.


After The Patching And Successful Regaining Of Vision, Do I still Need to Patch the Eye?

The patching should be done for at least 1-2 years. Once the vision regains in the lazy eye, the good eye should be patched for a few hours every day as there are chances that the lazy eye may relapse.

My Child Resists Applying Patch to Treat Lazy Eye. What are the Alternatives?

Following are the various alternatives to patching of the eye to fix lazy eye:-

1. Atropinization

Atropinization is done in kids who resist the patching and constantly try to peep over or through the edges of the patch. This is also called penalization because, in this method, the good eye is blurred with atropine drops3C;, T. J. (2007). 'Comparative efficacy of penalization methods in moderate to mild amblyopia' Source.

How Does Atropine Blur the Vision and Is it Better than Using Patch for The Treatment of Lazy Eye?

Atropine causes ciliary muscle relaxation and dilates the pupil. Dilatation of the pupil causes blurring of vision. This dilation can last for as long as ten days. The advantage of Atropinization is that the parent do not have to worry about the child cheating with the patch.

However, atropine has its side effects like sensitivity to the light, loss of accommodation, etc.

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2. Binocular Stimulation

Patching and Atropinization are usually done to stimulate one eye (mono ocular therapy). Newer methods focus on stimulating both eyes together4Pineles SL;Aakalu VK;Hutchinson AK;Galvin JA;Heidary G;Binenbaum G;VanderVeen DK;Lambert SR;. (2020, February). 'Binocular Treatment of Amblyopia: A Report by the American Academy of Ophthalmology' Source. Following are some of the binocular simulation techniques:-

a) Dichoptic Training

In Dichoptic Training, the stimulus is given to both the eyes individually, and the brain is forced to fuse the images. This training exercise helps the lazy eye focus on the image and send the signals to the brain to decipher the image. Regular training exercises have helped patients fix the lazy eye5JY;, L. X. (2017). 'Dichoptic training in adults with amblyopia: Additional stereoacuity gains over monocular training' Source.

 b) Binocular iPad Therapy

The patient is asked to play falling blocks game, also called as Tetris. This game is chosen for fixing lazy eye because it is easy to learn and play, and further, the patient needs to focus on arranging the falling shapes in a particular sequence to win the game.

This game is available in iPad and other digital devices and needs to be played in anaglyph 3D screen

The game is set up on the anaglyph 3D screen in such a way that:-

  •  The falling blocks are seen only by the lazy eye.
  •  The green block are seen by the fellow eye
  •  The ground blocks which are brown in color are seen by both the eyes

The game starts by exposing the falling blocks to the lazy eye in high contrast (red blocks), followed by the fellow eye at a lower contrast (green blocks). This helps the brain exercise for binocular combination.  

Patients are expected to play the game for 8 hours in 4 weeks. As per the study, the game improves the patient’s binocular vision, which eventually helps fix the lazy eye medical condition6Kelly KR;Jost RM;Dao L;Beauchamp CL;Leffler JN;Birch EE;. (2016). 'Binocular iPad Game vs Patching for Treatment of Amblyopia in Children: A Randomized Clinical Trial.' Source.

c) Interactive binocular treatment (I-Bit)

Interactive binocular treatment (I-Bit) therapy integrates dichoptic training with virtual reality games. In this game, the lazy eye is presented with dynamic images and the brain is forced to fuse the images which helps in improving the binocular vision and eventually help in fixing lazy eye medical condition7Herbison N;Cobb S;Gregson R;Ash I;Eastgate R;Purdy J;Hepburn T;MacKeith D;Foss A; ;. (2013, September). 'Interactive binocular treatment (I-BiT) for amblyopia: Results of a pilot study of 3D shutter glasses system.' Source.

                                                          

3. Vision Simulation Programs to Fix Lazy Eye

Following are some of the new programs which have proven to be successful in fixing the lazy eye

 a) Vision Therapy

Vision therapy utilizes certain filters, lenses, prisms, occluders, computer software, electronic gadgets with timers, and other programs to restore binocular single vision and equalize the vision in both eyes.

 

b) Revital Vision

Revital Vision is tried in adults who have not benefitted from patching. It is a neural training program that consists of a series of visual tasks to be performed by the lazy eye, thus training the brain to be more efficient in processing the information from that eye.


4. Localization Technique For Fixing Lazy Eye After Surgical Squint Correction

Localization is a procedure done in the weak eye, especially if there is eccentric fixation.

Eccentric fixation refers to a condition where the light rays, owing to the misalignment in cross-eye or squint, don’t focus on the fovea centralis but some other point in the retina. Normally vision is the clearest when light rays focus on the fovea centralis.

After the surgical squint correction, localized stimulation of the weak eye’s fovea centralis is done to enable the eye to see clearly. This is called as localization and it helps in fixing lazy eye medical condition8A;, F. M. (2000, December). 'Preliminary report: Monocular spatial localization in children with strabismic amblyopia' Source.


Role Of Parents In Helping Their Child in Recovering from Lazy Eye (Amblyopia) 

Parents play a vital role in fixing of Lazy Eye (Amblyopia). To efficiently help a child recover from Lazy Eye, the parents first need to educate themselves about the medical condition and realize the importance of sticking to the treatment regime in a disciplined manner.

- Educating Child About the Importance of Treatment

The parents have to further educate the child about not removing the patch and how it can affect the vision.

- Regular Follow Up with Ophthalmologist

The parents should also make sure to follow up with the eye doctor regularly, not only to monitor the improvement of the lazy eye but also to make sure that the good eye’s vision isn’t deteriorating due to constant blocking with patching or atropine.

- Regular Replacement of Patches

Patches can cause skin irritation and hence needs to be changed from time to time.

- Keep an Eye on Your Child 

Parents should keep an eye on their child (when wearing the patch) as there they are prone to accident, moving around with blurred vision.

- Don’t Let Your Child Cheat

Parents should make sure that their kid doesn’t cheat or peep over the patch, as that would defeat the very purpose of the treatment.

 

References

  1. 1
    Blair, K. (2020, August 10).
    Amblyopia.
    Retrieved November 16, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK430890/
  2. 2
    Chen Y;He Z;Mao Y;Chen H;Zhou J;Hess RF;. (2020, January).
    Patching and Suppression in Amblyopia: One Mechanism or Two?
    Retrieved November 16, 2020, from https://pubmed.ncbi.nlm.nih.gov/32009874/
  3. 3
    C;, T. J. (2007).
    Comparative efficacy of penalization methods in moderate to mild amblyopia.
    Retrieved November 16, 2020, from https://pubmed.ncbi.nlm.nih.gov/18207121/
  4. 4
    Pineles SL;Aakalu VK;Hutchinson AK;Galvin JA;Heidary G;Binenbaum G;VanderVeen DK;Lambert SR;. (2020, February).
    Binocular Treatment of Amblyopia: A Report by the American Academy of Ophthalmology.
    Retrieved November 16, 2020, from https://pubmed.ncbi.nlm.nih.gov/31619356/
  5. 5
    JY;, L. X. (2017).
    Dichoptic training in adults with amblyopia: Additional stereoacuity gains over monocular training.
    Retrieved November 20, 2020, from https://pubmed.ncbi.nlm.nih.gov/28736224/
  6. 6
    Kelly KR;Jost RM;Dao L;Beauchamp CL;Leffler JN;Birch EE;. (2016).
    Binocular iPad Game vs Patching for Treatment of Amblyopia in Children: A Randomized Clinical Trial. Retrieved November 16, 2020, from https://pubmed.ncbi.nlm.nih.gov/27832248/
  7. 7
    Herbison N;Cobb S;Gregson R;Ash I;Eastgate R;Purdy J;Hepburn T;MacKeith D;Foss A; ;. (2013, September). Interactive binocular treatment (I-BiT) for amblyopia: Results of a pilot study of 3D shutter glasses system.
    Retrieved November 16, 2020, from https://pubmed.ncbi.nlm.nih.gov/23807383/
  8. 8
    A;, F. M. (2000, December).
    Preliminary report: Monocular spatial localization in children with strabismic amblyopia.
    Retrieved November 16, 2020, from https://pubmed.ncbi.nlm.nih.gov/11262684/

Not to Be Missed..

This content is only for educational purpose and should not be considered as a substitute for your Physician's/Doctor's clinical judgement

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