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Amblyopia(Lazy Eye)

Pronounced: Am-blee-o-pee-a

Definition

Amblyopia, often called lazy eye, is a condition that occurs when there is a reduction of vision in 1 eye that is not correctable with glasses.

There are two common types of amblyopia:

  • Anisometropic amblyopia—Vision in one eye differs from the other. This is often caused by a large difference in eyeglass prescription. The difference may be caused by 1 eye being more nearsighted or farsighted than the other, or by large differences in astigmatism.
  • Strabismic amblyopia— Visible misalignment (crossing) of one eye.

Strabismic Amblyopia

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The sooner amblyopia is treated, the more favorable the outcome.

Causes

Amblyopia is caused when the brain prefers (favors) one eye to the other. The brain’s preference (liking) for one eye over the other can weaken and reduce vision in the eye that is less used.

There are no apparent genetic or environmental factors that can be attributed to causing amblyopia.

Risk Factors

Amblyopia is more common in children under 10 years old with:

  • Crossed eyes
  • A large difference in sight between the 2 eyes that may be:
    • Unnoticed
    • Detected by a large difference in eyeglass prescription
  • Visual blockage such as a cataract, droopy eyelid, or corneal scarring

Amblyopia can also occur in adults.

Symptoms

Some people with amblyopia may not have symptoms. In those that have them, amblyopia may cause:

  • A droopy (the inability to fully-open) eyelid that blocks the pupil
  • Headaches
  • Blurry vision
  • Excessive squinting or closing of the eyes
  • Repeatedly closing of one eye in bright sunlight
  • Crossing of one eye, generally the eye that is less used will excessively turn toward the nose

Symptoms vary depending on the extent of the amblyopia.

Diagnosis

Your eye doctor will ask about your symptoms and medical history. An examination of your eyes will be done. Since amblyopia tends to occur in young children, the types of tests their eye doctor will perform will be determined by their age and ability to respond.

Tests to evaluate the eyes may include:

  • Visual acuity assessment testing (VAT)—to assess distant vision
  • Cycloplegic refraction test—to assess how the eyeball displays and receives images produced by the lens of the eye
  • Retinoscopy—to determine a preverbal child’s eyeglass prescription
  • Prisms—to determine the amount of crossing between the 2 eyes
Treatment

Treatment includes correcting visual obstructions, such as cataracts and other visual abnormalities.

Talk to your doctor about the best option for you. These may include:

Atropine Penalization

Atropine drops or ointment is placed in the non-amblyopic eye. This causes the sound eye to become unfocused and forces the use of the lazy eye.

Occlusive Therapy

Occlusive therapy involves using a patch over the non-amblyopic eye (the sound eye), forcing the use of the lazy eye.

Bangerter foils are another option. The foils, which are made of thin vinyl, are placed over the eye glass lens, covering the non-amblyopic eye. Just like with the patch, this forces the weaker eye to become stronger because you will not be able to see well with the foiled lens.

Prevention

While there are no current guidelines to prevent amblyopia, vision screening can help to detect the condition at an early age. Children under aged 3-5 (or younger) should be examined for eye problems.

RESOURCES:

Eye Smart—American Ophthalmology
http://www.geteyesmart.org

National Eye Institute (NEI)
http://www.nei.nih.gov

CANADIAN RESOURCES:

Canadian Ophthalmological Society
http://www.cos-sco.ca

The Canadian National Institute for the Blind
http://www.cnib.ca

References:

Amblyopia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 13, 2012. Accessed June 30, 2013.

Bhola R, Keech RV, et al. Recurrence of amblyopia after occlusion therapy. Ophthalmology. 2006;113(11):2097-2100.

Campos, EC, Schiavi, et al. Effect of citicoline on visual acuity in amblyopia: preliminary results. Graefes Arch Clin Exp Ophthalmol.1995;233(5):307-312.

Fleck BW. Amblyopia therapy. Br J Ophthalmol. 2003;87(3):255-266.

Flynn JT, Schiffman J, et al. The therapy of amblyopia: An analysis of the results of amblyopia therapy utilizing the pooled data of published studies. Trans Am Ophthalmol Soc. 1998;96: 431-450; discussion 450-453.

Holmes JM, Beck RW, et al. Pediatric Eye Disease Investigator Group. Impact of patching and atropine treatment on the child and family in the amblyopia treatment study. Arch Ophthalmol. 2003;121(11):1625-1632.

Kushner BJ. Atropine vs. patching for the treatment of moderate amblyopia in children. Arch Ophthalmol. 2002;120(3):387-388.

LaRoche GR. Amblyopia: Detection, prevention, and rehabilitation. Curr Opin Ophthalmol. 2001;12(5):363-367.

Leguire LE, Rogers GL, Walson PD, Bremer DL. Occlusion and levodopa-carbidopa treatment for childhood amblyopia. J AAPOS.1998;2(5).

Loudon SE, Simonsz HJ. The history of the treatment of amblyopia. Strabismus. 2005;13(2):93-106.

Ohlsson J, Baumann M, et al. Long term visual outcome in amblyopia treatment. Br J Ophthalmol. 2002; 86(10):1148-51.

Pediatric Eye Disease Investigator Group. A comparison of atropine and patching treatments for moderate amblyopia by patient age, cause of amblyopia, depth of amblyopia, and other factors. Ophthalmology . 2003;110(8):1632-7; discussion 1637-8.

Powell C, Porooshani H, et al. Screening for amblyopia in childhood. Cochrane Database Syst Rev. 2005;(3):CD005020.

Quinn GE, Beck RW, et al. Pediatric Eye Disease Investigator Group. Recent advances in the treatment of amblyopia. Pediatrics. 2004;113 (6):1800-1802.

Sakatani K, Jabbur NS, et al. Improvement in best corrected visual acuity in amblyopic adult eyes after laser in situ keratomileusis. J Cataract Refract Surg. 2004;30(12):2517-2521.

Simons K. Amblyopia characterization, treatment, and prophylaxis. Surv Ophthalmol. 2005;50(2):123-166.

5/28/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Pediatric Eye Disease Investigator Group Writing Committee, Rutstein RP, Quinn GE, et al. A randomized trial comparing Bangerter filters and patching for the treatment of moderate amblyopia in children. Ophthalmology. 2010;117(5):998-1004.

2/4/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: US Preventive Services Task Force. Vision screening for children 1 to 5 years of age: US Preventive Services Task Force recommendation statement. Pediatrics. 2011;127(2):340-346.



Last reviewed October 2014 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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