Do you suffer from lazy eye? Here's why and what you should do with amblyopia

By Cristiano Antonino On Jul 28, 2023

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Lazy eye, also called amblyopia, indicates the presence of hypovisus in one eye. This disorder is common among children where it is the leading cause of visual impairment

It manifests itself in the first years of life and is caused by a lack of neuronal and visual development.

If lazy eye is not treated immediately, acting promptly, the visual deficit becomes irreversible.

Lazy eye: what is it?

Lazy eye is the most common cause of monocular visual impairment among young people and adults.

If left untreated in the developmental stage of children, it can lead to permanent vision loss in the affected eye.

The condition affects 4% of the world’s population and causes a reduction in the visual capacity of only one eye (more rarely both).

Amblyopia is, in essence, an alteration in nerve signal transmission between the eye and the brain.

The latter favours one eye over the other due to reduced visual acuity.

It is a disease that can be successfully treated in the first 5-6 years of a child’s life.

Lazy eye: causes

Amblyopia occurs when the brain and the eye process visual input differently.

This happens if the nerve pathways that connect the two organs are not stimulated properly.

This pathology can be caused by any factor that alters the normal development of the eyes.

For example, if there is strabismus, in which the eyes are not aligned and do not look in the same direction.

Lazy eye can also be related to differences in the quality of vision between the two eyes caused by refractive defects such as myopia, astigmatism or presbyopia.

More sporadically, this condition can be traced back to eye diseases such as cataracts.

In general, lazy eye is a condition that is caused by a problem in the normal development of vision.

In the human body, the brain and the eye work together to acquire and process visual information.

The retina translates images into nerve signals and transmits them to the brain, which develops them.

In children, it takes 3-5 years for the brain to learn to interpret visual stimuli, and until the age of 7 the visual system continues to develop.

If during growth an eye is hindered in its development by one of the causes listed above, the quality of signals, and consequently of images, becomes chaotic.

The child, therefore, begins not to see well out of one eye, thus relying only on the other for vision.

Over time, the brain begins to rely more and more on the eye that works perfectly (called the dominant eye), neglecting instead the impulses coming from the amblyopic one, which will therefore remain visually impaired.

In children, the most common causes are strabismus, a common disorder that has at its origin a muscular imbalance that prevents the alignment of the eyeballs, and refractive errors.

More commonly, lazy eye is caused by the combination of strabismus and anisometropia, i.e. an important difference in the refractive status of the two eyes.

In adults, amblyopia can appear in the presence of congenital cataracts, but it can also be a sign of more serious diseases such as eye cancer, glaucoma, corneal ulcers or scars and ptosis (drooping eyelid).

Lazy eye: symptoms

Lazy eye has as its first symptom a deficit in vision that can be very slight or severe.

In children, it is possible to interpret certain signs that can help parents understand if the problem is present.

Usually, children either do not understand that something is wrong with their vision or do not have the ability to explain the discomfort they are experiencing.

Most of the time, adults realise that something is wrong when children begin to engage with drawing, reading or writing.

Special attention should be paid to young patients who present with eyelid ptosis or strabismus and may therefore develop lazy eye.

The symptoms of amblyopia include a difficulty in seeing the eye that causes an involuntary movement of the eye inwards or outwards.

Individuals with this disorder have a low sensitivity to movement and contrast, as well as a difficulty in perceiving depth.

This means that a child with amblyopia may have difficulty grasping a ball.

How is the diagnosis made?

Lazy eye is a treatable condition, but it must be diagnosed early.

Most of the time, especially in the absence of obvious symptoms, the condition is diagnosed through a routine check-up by the ophthalmologist who will plan the course of treatment.

Although special attention is paid to those with a family history of eye disease, all children between the ages of 3 and 5 should have a comprehensive eye test and check-ups every two years.

In addition, the figure of the orthoptist, a professional figure who implements and verifies the patient’s progress in the therapeutic programme by proposing customised exercises according to the severity of the disorder, the patient’s age and needs, is fundamental in visual rehabilitation.

The orthoptic assessment can be used to determine eye alignment, colour perception, ocular motility and contrast sensitivity.

The examination lasts about half an hour and includes some tests that are neither invasive nor painful, carried out by the patient under examination.

How is lazy eye treated?

Lazy eye is usually treated by correcting the vision problem.

Early and effective treatment prevents the problem from continuing into adulthood.

If there is a refractive disorder at the origin, glasses will be prescribed.

Afterwards, the doctor encourages the child to use the eye with the visual defect more, either by covering the dominant eye with an eye patch or by applying drops of atropine.

This treatment is effective in the long term and involves a gradual recovery of sight that occurs over several months.

Lazy eye: treatment with patch or eye drops

The aim, therefore, is to stimulate the use of the ‘weaker’ eye, preventing vision with the dominant eye.

Treatment is carried out using various methods, one of the most common being patching, i.e. occlusion with a patch.

The therapy involves the application of an opaque patch over the dominant eye, thus forcing the patient to use the other.

The success of the treatment takes months and also depends on the cooperation of the child, who will have to wear the patch several hours a day.

In order to make the treatment more effective, ophthalmologists recommend activities such as reading or watching TV during the time the person is wearing the patch.

In some cases, the doctor may decide to apply an atropine-based eye drops to the dominant eye to temporarily blur vision.

This treatment helps the brain learn to manage vision, but it has side effects.

Drops of the medicine can cause irritation and redness of the eyes and skin, as well as headaches.

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The opportunity to have excellent results with this treatment ends around the age of 6, when visual development is almost complete.

It therefore becomes important to detect this condition early by having the child undergo regular examinations and thus be able to intervene at an early stage.

Treatment with corrective lenses

When lazy eye is caused by vision problems such as astigmatism, nearsightedness or farsightedness, the ophthalmologist will prescribe corrective lenses before starting any occlusion therapy.

They should be worn daily by the child, who will have to undergo regular check-ups to assess the success of the treatment and progress.

In some cases, the prescription of glasses also corrects or improves any strabismus present.

Surgical treatment

In some cases, when amblyopia is caused by strabismus or a congenital cataract, surgery is necessary.

The child will be monitored in the following months with regular check-ups.

Lazy eye: course and possibility of cure

Lazy eye is a condition that can be cured, but it requires early diagnosis and equally fast treatment.

Children who receive appropriate treatment before the age of five most often recover completely, recovering their sight and living as adults without any problems.

Only in rare cases may they have difficulty perceiving depth for a shorter or longer period of time.

On the contrary, if not treated in time, amblyopia can cause a permanent visual impairment, also leading to muscular problems that can only be resolved by surgery.

After the age of 5, treating a lazy eye is more difficult.

Between the ages of 6 and 9, in fact, the visual system of children develops rapidly and the plasticity of the neurovisual system is reduced.

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