By: Eniolami O. Dosunmu, MD, MPH, FAAO, FAAP

Amblyopiaalso known as “lazy eye”, is a common eye disease in children. It develops when a child has an eye that does not see well. This is due to a poor connection between the eye and the brain, which can happen for various reasons. Amblyopia is more common in one eye, but can also occur in both eyes.

Why is it important to treat amblyopia early?

To restore normal vision in the affected eye, it is important to detect amblyopia as early as possible and treat it correctly. If the problem continues for too long, after a certain age, vision is often lost permanently.

What causes amblyopia?

Amblyopia can develop in different ways, but all involve the brain not getting clear, balanced input from both eyes.

There are different types of amblyopia, including:

• 
  Strabismic amblyopia: When one eye is not in line with the other. The eye could be turned inwards, outwards, upwards or downwards. When the two eyes do not see the same thing, the moving or wandering eye will lose vision.
• 
  Deprivation amblyopia: When there is something within the visual pathway that limits vision. For example, a cataract (clouding of the lens) or a ptosis (hanging) eyelid will block vision and lead to amblyopia.
• 
  Refractive amblyopia: When an eye needs glasses to see well. The brain will not be able to form a proper image if the information it receives from the eye is out of focus and the eye develops amblyopia.

How is amblyopia treated in children?

There are a number of treatment options for amblyopia:

Glasses

Using the correct glasses so that the eye has a clear image to send to the brain is a very powerful treatment for refracting amblyopia. This is very effective for bilateral (both eyes) refractive amblyopia and for unilateral refractive amblyopia.

Eye patch therapy

Once one
ophthalmologist diagnoses the problem in the weaker eye, your child may need to wear a patch over the “good” eye for periods of time. This forces them to use and strengthen the eye that has become “lazy”. Patching therapy will be continued as long as necessary to bring the weak eye up to its full potential and keep it there. This can take weeks, months or even a few years.

Eye drops or ointment

As an alternative to an eye patch, the ophthalmologist may prescribe eye drops or ointment to blur the vision in the good eye and force the weak eye to work and be strengthened. This can stimulate your child to use the amblyopic eye. Like patching, this may take a longer period of time for treatment to complete.

Binocular vision therapy

There are newer treatments for amblyopia. These treatments use digital technology to focus on both eyes.

There are two FDA-approved treatments in the United States. Luminopia uses a virtual reality platform where the image seen by the stronger is changed; this allows the weaker eye to improve vision. Curesight uses an eye-tracking platform and special glasses that affect the central vision of the strong eye so that the weaker eye can improve.

Lumonipia is FDA-approved for children ages 4-12, and Curesight is FDA-approved for ages 4-9. Both have been shown to be effective in treating amblyopia. However, cost can be a limiting factor for these treatments, as they may not be covered by all insurance plans.

Is surgery a treatment for amblyopia?

Surgery may be used along with the therapies above to treat amblyopia. However, it cannot be the only treatment used for amblyopia. For example, surgery to remove a cataract may be necessary for deprivation amblyopia, along with glasses and patching.

An examination by a pediatric ophthalmologist will be helpful when making decisions about amblyopia treatment for your child.

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