I’m sure you’ve heard, if not used, the term lazy eye.  Some people use lazy eye to refer to the condition known formally as amblyopia.  The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) article on amblyopia begins, “A common vision problem in children is amblyopia, or ‘lazy eye.’ It is so common that it is the reason for more vision loss in children than all other causes put together.”  They go on to describe amblyopia as: “…a decrease in the child’s vision that can happen even when there is no problem with the structure of the eye. The decrease in vision results when one or both eyes send a blurry image to the brain. The brain then ‘learns’ to only see blurry with that eye, even when glasses are used. Only children can get amblyopia. If it is not treated, it can cause permanent loss of vision.”

First of all, when they use the word vision they really mean eyesight - how clearly one sees.  The visual process, in addition to simply seeing clearly, includes eye movements, eye teaming, focusing and peripheral awareness.  I would also add that amblyopia often has little to do with what the eye is sending to the brain.  It would seem to make sense that since, as the AAPOS clearly stated, “there is no problem with the structure of the eye” it should remove blame from the eye and place it where it clearly (no pun intended) belongs - on the brain.  We do not see with our eyes.  We see with our brains.  The eyes aren’t only a window to the soul, they provide a window through which light can make contact with the brain.  And this is how the visual process begins.

You’ve probably heard someone say that the eye is like a camera.  Not really.  Yes there might be some use in describing the eye as having an image created inside it (like a camera), which it sends to the brain.  This is not a particularly helpful description even though it sounds good.  If there was in fact such an image at the back of the eye, you should know that it would be tiny, upside-down and flipped side-to-side as well.  The clearest part of the “image” would be about a millimeter in size.  But that’s not really where I wanted to go with this topic.

Many medical doctors insisted until very recently that it was impossible to improve the sight in an amblyopic eye after the age of seven.  There was never any proof of this opinion.  The truth was, and remains, that amblyopia could not begin after around age seven.  For some reason, the medical community decided that this meant it could not be treated after age seven.  Nothing could be further from the truth.  Behavioral optometry has known this for many decades and now science is catching up with us; the medical community remains - shall we say - hesitant.  The medical community only recently began speaking of amblyopia as having anything to do with the brain instead of the eye, or that the brain learns how to see.  I am very glad that they are finally coming around on some of this. 

More and more research proving that amblyopia can be treated at any age is emerging all the time.  This is not to say that there is a guarantee of success in every case, but behavioral optometry, thanks to vision therapy and the strategic use of lenses, offers the best chance of achieving this goal.  The other important thing to consider about vision therapy is the fact that it is non-invasive.  I believe that vision therapy is also superior because it is interactive and relies on at least some amount of input from the person; vision therapy is not something done to someone but with someone.  There is no such thing as an anesthetized vision therapy patient.

Speaking of anesthetized, most medical doctors who treat amblyopia still insist that the only thing likely to work is to patch the so-called good eye for a few months and either everything will be great or just give up.  Good eye is another phrase I avoid at all costs since the visual process, whether operating smoothly and effectively or struggling, occurs in the brain with input from all over the body - from the balls of the feet to the balls of the eyes.  It is the brain that aims the eyes; it is the brain that enables the two eyes to function as an integrated unit.  In any event, all this eye patching can sometimes result in better sight in the affected eye, but as often as not that improvement will wear off fairly quickly once the patching is stopped.  This is because the brain just goes back to doing what it was always doing without the patch and everything is then likely to go back to the way it was.  Some surgeons claim that they can fix amblyopia with surgery.  I still haven’t figured out how that might be possible, especially since the surgery is done on the eye muscles and not the brain (thankfully).  The best way to deal with amblyopia is to find a behavioral optometrist who offers vision therapy and uses lenses to stimulate the visual system, not just to make things clear.  We want to see if we can get the brain to see clearly on its own before resorting to lenses for that purpose.

Next time: Who you calling lazy? Part 2