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Posted on 09-19-2013

Who You Calling Lazy? Part 2

Originally posted on January 15th, 2013

Last time we began talking about amblyopia, an eye that cannot seem to see as well as its partner, and commonly referred to as a lazy eye.  I mentioned that I didn’t like the term lazy eye, but I never actually got around to explaining why I don’t like the term lazy to describe such an eye.  We will get there, I promise.  But there are a few more things to cover first.

Lazy eye is also used to refer to an eye that does not appear to be pointing where it should; this is formally known as strabismus.  Eyes that turn in are called esotropic, eyes that turn out are exotropic.  Unfortunately the most common treatment for eye turns, and still the only one offered or accepted by the most of the medical community, is eye muscle surgery or strabismus surgery.  Strabismus surgeries pre-suppose that changing the effective length of an eye muscle will alter the function of that muscle in a desired way and to a desired degree.  One problem with this theory is that these surgeries are, in the vast majority of cases, performed on healthy eye muscles.  It is very rare for someone to have a damaged eye muscle - even when strabismus and/or amblyopia are present. 

Think about this.  Many parents have come to me for a second opinion, looking to avoid strabismus surgery for their child.  Quite a few have said to me that the surgeon told them there was “nothing wrong with the child’s eye muscles, but that’s how we fix it.”  These parents had a hard time reconciling all this and were justifiably hesitant to go along with the plan associated with this thinking.  These concerned parents all ended up doing their own research and they decided that trying vision therapy was a more sensible, safer option.  Obviously I agree with them.

Somewhere along the way somebody decided that a lazy eye must be forced to work or else spend the rest of its life wandering aimlessly or worse, living in its mother’s basement, never finishing college and never finding a good job.  This is no future for any self-respecting eyeball. 

Many doctors still insist on treating what they still persist on calling lazy eye by prescribing full-time patching of the so-called good eye.  This approach of course results from the mindset that the eye is to blame, which is extremely rare.  As I mentioned last time, this language is neither accurate nor productive.

These eyes are referred to as lazy either because they don’t see clearly or because they don’t work as part of a team with the other eye as far as where they aim while the so-called good eye is pointing at something.  But an eye like this should never be thought of as lazy since if anything, it is being heroic by getting out of the way so the person can be more comfortable and successful at life.  Such a poorly-seeing eye could just as easily cause even more problems if the brain keeps trying to integrate it with the other eye.  This Heroic Eye has decided not to fight for attention since all it seems to do is make life more difficult.  Of course this rarely happens at the conscious level and, as I hope I’ve made clear, this is rarely about the eye or eyes.  It’s all about the brain. 

If you are looking for help with amblyopia or strabismus be sure to find someone who understands that it's not just an eye thing. Make sure you find someone who knows that surgery and patching are not the only ways to treat strabismus and amblyopia. At least get an opinion from someone who understands visual development, the brain's role in the visual process and the great possibilities for improvement available with vision therapy and therapeutic lenses.

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