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lazy eye

Treatment for Lazy Eye / Amblyopia in Ancaster

The Ancaster Vision Therapy Centre offers vision therapy to effectively treat amblyopia (lazy eye) in children and adults alike using the latest, proven methods of neuro-optometric therapy and developmental optometry—generally referred to as Vision Therapy.

What is Amblyopia?

Amblyopia, commonly referred to as “lazy eye”, is a condition where the brain and eyes are not functioning together in unison the way they should. This results in a loss of vision, usually as a significant difference in power between the eyes.

Amblyopia generally starts at birth or during early childhood. Since amblyopia often doesn’t have any obvious symptoms, it can go unnoticed for years as the situation deteriorates. Parents and even health care professional, therefore, are not always aware that there is a problem until the amblyopia is well-established. It takes an experienced developmental optometrist to diagnose amblyopia early. The earlier the diagnosis, the easier and faster the treatment for amblyopia using Vision Therapy.

Amblyopia is often confused with Strabismus (eye-turns), which is further confused by the fact that amblyopia can be strabismic, although that isn’t always the case. Essentially, if a person has amblyopia, one eye or the other is deemed weaker by the brain, so it stops processing as much visual information from the weaker eye so as to compensate in favor of the more powerful eye. Sometimes, both eyes fail to develop clear vision. This imbalance or general lack of power in the eyes is amblyopia.

Amblyopia leads to poor visual acuity, but more importantly, it leads to poor eye coordination and poor depth perception. It can lead to clumsiness, tripping or knocking into things, and difficulty with catching a ball accurately. It may lead to difficulties with reading and learning.

Symptoms of Amblyopia and Resulting Problems

Amblyopia often results in the following problems:

  • Reading and learning problems
  • Severe lack of vision in one eye
  • Strabismus with exotropia (eye turns to the outside)
  • Strabismus with esotropia (eye turns to the inside)
  • Double vision
  • Cloudy vision in one eye
  • Eyes that appear to not work together
  • Poor depth perception
  • Squinting or shutting an eye
  • Head tilting
  • Abnormal results of vision screening tests
  • Poor depth perception
  • Problems with contrast and visual acuity
  • Difficulty focusing or maintaining physical focus
  • Attention problems associated with ADD/ADHD

The common misconception is that amblyopia or lazy eye is always accompanied by a visible misalignment of the eyes. The condition of eyes being misaligned is called strabismus, also called a wandering eye and often it can be the cause of the amblyopia. However, amblyopia doesn’t always coincide with strabismus, and it may not even be detectable at all without close examination.

What Causes Amblyopia?

Amblyopia is usually caused by at least one of the following three conditions:

  1. Strabismus, wandering eye, or eye turns, where the eyes fail to align either vertically or horizontally. This is referred to as strabismic amblyopia.
  2. Refractive issues such as nearsightedness, farsightedness, and distortions caused by astigmatism.
  3. Congenital Cataracts
Visual Field Loss
Strabismus

Strabismus is often referred to as having Crossed Eyes, Wandering Eyes, or Wall Eye.  It is the inability to point both eyes in the same direction at the same time.

  • Esotropia: one eye may turn in relative to the other
  • 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

The eye turn may occur constantly or only intermittently. If it is constant, that means that it occurs all or much of the time.  Intermittent means that it occurs only some of the time, such as only when a person is tired or has done a lot of reading.

It may alternate, which means that at times one eye turns while at other times, it is the other eye that turns.

Strabismus may cause double vision (diplopia).  In order to avoid seeing double, vision in one eye may be ignored (suppressed).

If this occurs from birth or soon after, then the ignored eye does not develop the “wiring” or signal to the brain, and this ends up causing a lazy eye (amblyopia).  This means that the wiring between the eye and the brain has not developed.  Amblyopia (lazy eye) can occur even if the eyes are pointing straight.

Strabismus is treated by some combination of special eyeglasses, prisms, surgery, or Vision Therapy. The right treatment depends on the cause of the strabismus. Surgery often makes the eyes appear straight, but the visual system is still not balanced between the eyes. Most of the time, lasting and effective treatment for strabismus requires Vision Therapy.

Double Vision & Brain Injury
Bilateral & Unilateral Amblyopia

Bilateral Amblyopia ― amblyopia in both channels/eyes ―occurs when the power (prescription) in both eyes is very high, and therefore clear vision does not develop in either eye.

It's important to correct amblyopia as early as possible before the brain ignores vision in the affected eye. However, amblyopia IS treatable in adults as well. The brain is remarkably plastic, and this plasticity allows for Vision Therapy to be effective even when treating adults with Amblyopia.

Unilateral Amblyopia occurs when the brain does not receive a clear image from one eye because of a large difference in the prescription (nearsightedness, farsightedness and/or astigmatism) of the two eyes. Here too, the brain does not develop the information from that eye (channel).

Visual Balance Disorders
Congenital cataracts

Congenital cataracts are opaque or cloudy coverings which distort vision (cataracts) that are present from the time of birth. The severity of congenital cataracts can vary from minor to full visual impairment and can occur in one eye (unilateral) or both eyes (bilateral). This condition is usually caused by genetic preconditions and/or metabolic disorders. Congenital cataracts can result in amblyopia, which can persist even after the cataracts are removed.

What is vision therapy for amblyopia?

Vision therapy is a customized applied series of exercises and techniques which retrain the neuro-visual system. This treatment can include the use of computer programs, games, and various non-digital exercises serve to enhance the neuro-visual system—the interplay between the brain and the eyes. In effect, the brain relearns how to properly and more effectively operate and interact with the eyes. Vision therapy is a customized, multi-session therapy that works with the patient, training the brain and the eyes in unison and constantly adjusts to the progress of the individual patient.

Speak to our Developmental Optometrists, at the Ancaster Vision Therapy Centre serving Hamilton, Brantford, Kitchener & Waterloo. Our eye clinic staff will be happy to walk you through the process and book your first appointment.

Research on Vision Therapy and Treatment for Amblyopia for Children and Adults

While they have been treating amblyopia for years, the eye doctors are still conducting research to improve upon the current knowledge. The amblyopia project keeps track of many of the articles that publish the results.

The below link is a paper on treating amblyopia.

http://www.nzosi.com/uploads/1/0/2/6/10263349/a_binocular_approach_to_treating_amblyopia_.11_aug13.pdf

The below link is a study they did on amblyopia and binocular vision.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577063/

The below link is about treating amblyopia using binocular iPad treatment.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4793887/

The below link is about amblyopia and the quality of life.

https://www.nature.com/articles/eye20114.pdf

The below link is about the treatment history of amblyopia.

A study of two adult patients whose amblyopia was improved when they're good eye became cataractous.

https://www.healio.com/ophthalmology/journals/jpos/1992-3-29-2/%7Bf29b1dd7-95ff-4eec-889d-f0afac45f7ad%7D/adult-amblyopia-reversed-by-contralateral-cataract-formation

Improved basic representation using perceptual learning in adults with amblyopia.

http://www.pnas.org/content/101/17/6692.short

Restoration and treatment of underdeveloped cortical functions in adults with amblyopia.

https://content.iospress.com/articles/restorative-neurology-and-neuroscience/rnn00450

Adult amblyopia and the prolonged perceptual learning of Positional acuity.

http://www.jneurosci.org/content/28/52/14223.full

Adult amblyopia binary home-based treatment using an iPod.

https://onlinelibrary.wiley.com/doi/full/10.1111/cxo.12192

Structure, plasticity, and suppression in adults with amblyopia.

https://onlinelibrary.wiley.com/doi/full/10.1111/opo.12123

Many new scientific studies show that therapy in patients with amblyopia successfully improve eyesight.

http://www.lazyeye.org/lazy-eye-amblyopia-age-treatment-adult.html

Amblyopia Questions and Answers

Does Patching or Atropine Treat Amblyopia?

Not exactly. These treatments may be used complementarily, but are inferior on their own to Vision Therapy. This is because patching and atropine do not address the underlying neuro-visual problems which result in the amblyopia in the first place.

Patching is commonly recommended to treat amblyopia, but it’s really an outdated and ineffective treatment. Atropine drops are sometimes recommended in place of patching. The idea behind both patching and atropine is that these treatments “penalize” the good eye, the weaker eye is forced to adjust and gain focus.

The problem with patching and atropine on their own is that penalization doesn’t treat the underlying neuro-visual cause of the amblyopia!

 Patching or atropine drops only address the symptoms. Visual acuity can be enhanced without Vision Therapy, but this is usually temporary. Amblyopia isn’t about one eye or the other being a problem. The research is conclusive that that approach is an over-simplification. Amblyopia is ultimately all about the overall ability of the brain to use both eyes together effectively. This is referred to as “eye-teaming” and improving the ability to team the eyes is essential to an effective and long-lasting treatment of amblyopia. The best and most effective solution for treating amblyopia is vision therapy.

Will my Child Outgrow Lazy Eye / Amblyopia?

No. This is a common myth that is still perpetuated by many healthcare providers. Amblyopia does not go away on its own. Untreated, it will significantly and negatively affect a child’s ability to learn, thrive, and function academically and socially. The earlier the treatment of lazy eye, the better.

As you get older, eye patching and atropine therapy tend to be even less effective than it is for, children. This is NOT the case with Vision Therapy. While the techniques may take a little longer, Vision Therapy is still a proven technique for treatment. If you would like to discuss if Vision Therapy is right for you, contact our caring staff at the in , . Our Vision Therapy experts, will be able to evaluate your amblyopia and decide on the best course of action.

Can Adults be Treated for Lazy Eye / Amblyopia?

Yes. The common wisdom is that lazy eye can only be treated in early childhood. While this is preferable, Vision Therapy can and is effectively used to treat lazy eye in adults as well. The brain is still plastic throughout adulthood and can adapt and change even once it’s fully developed. This means that the activities and exercises of Vision Therapy are effective for adults as long as the patient is diligent in following the treatment through. It requires a bit of discipline and taking an active role in the treatment regimen.

Can I have LASIK surgery if I have amblyopia?

Ophthalmologists will not typically perform LASIK on the so-called good eye in an individual that has amblyopia. The recommended approach is to have the amblyopia treated first through Vision Therapy. An alternative option for vision correction is Orthokeratology (Ortho-K), which uses a special, rigid contact lens at night which gently reshapes the cornea. This leaves the wearer with corrected vision during the day, without the need for glasses and contact lenses. In children, Ortho-K is also proven to slow the progression of myopia, which significantly decreases your child’s long-term risk of serious eye diseases such as retinal detachment and macular degeneration.  

Can I serve in the military if I have amblyopia?

Probably. There is a list of entry requirements for people with amblyopia, so it depends upon where you fall within these categories. The more severe cases of amblyopia will not be accepted. We recommend scheduling a developmental eye exam to assess your eligibility for military service.

Does computer use make amblyopia worse?

There is no direct link between computer use and amblyopia. Computer use, however, is not without its own problems. The high energy blue light from modern LED screens can cause eyestrain, soreness, blurriness, and likely long-term damage to the retina. Extended computer screen use can also exacerbate the symptoms of dry eye. At the Ancaster Vision Therapy Centre, we recommend using blue light protective lenses and taking frequent breaks to look at objects at a distance. This applies whether or not you have amblyopia.

How much does Vision Therapy for Amblyopia Cost?

The cost of Vision Therapy for amblyopia depends on how long and intensive the required treatment is. This will depend on the severity of the amblyopia, age, and how responsive you are to the treatment. There is no single answer for how many treatments will be required. Vision Therapy is customized to each patient’s individuals needs and everyone responds at their own pace.

The most important thing to keep in mind is the cost of NOT getting effective treatment. It can result in a lifetime of difficulty interpreting visual symbols, problems with reading, and academic and professional failure.

Is Vision Therapy for Amblyopia covered by health insurance?

Every medical plan is different. However, for the time being, most Vision Therapy is not covered by the majority of medical or vision insurance plans, including OHIP. However, you also need to consider the cost to you or your child’s life success if amblyopia is not effectively treated.

Can I treat amblyopia at home?

There are activities that you can perform at home like eye patching or certain eye exercises. However, long-term effective treatment will also require in-office Vision Therapy with an experienced expert. Only a developmental optometrist or vision therapist can assess the progress of your treatment and customize the treatment plan that’s right for you. Home exercises without the ongoing supervision of a vision therapist will have limited success, if any, and are not recommended.

Serving Patients From:

Ancaster | Hamilton | Brantford | Kitchener & Waterloo | and Southern Ontario

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