What is Lazy Eye?

Lazy eye, referred to medically as amblyopia, is a condition when there is a decrease in a person's eyesight due to a lack of proper development of the visual system early on in life. The weaker eye which is nicknamed the ‘lazy eye’ is misaligned and it wanders inwards or outwards. This condition almost always occurs in only one eye, but there are rare cases where both eyes can have amblyopia. Children generally tend to develop a lazy eye anywhere from birth up until around age 7.

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When to See the Optometrist

It is recommended by the American Optometric Association that all children have an eye exam at six months and then at age 3. During this visit the optometrist will diagnose if there is a lazy eye or any other eye conditions. Due to the visual needs in a classroom, all children are recommended to have a developmental eye exam before starting first grade, this will help identify issues that may impact their ability to read and learn.

If you notice that your child’s eyes appear to be crossed, any time after an infant is a few weeks old, it’s important to schedule an eye exam so that the optometrist can diagnose if there is amblyopia. Moreover, if there is a family history of childhood eye conditions such as having a lazy eye or cataract in childhood, it’s highly recommended to have your children scheduled for an eye exam. After the initial visit, the optometrist will recommend how frequent your child should come for routine eye exams.

Symptoms and Signs

A child with amblyopia often does not have symptoms and the best way to identify a lazy eye is with a developmental eye exam.

The possible symptoms include:

The eye wanders inward or outward
Eyes do not seem to work together
Poor vision and/or depth perception
Head tilting
Shutting or squinting one eye

Risk Factors

Some children are more prone to develop a lazy eye. The risk factors include:

Family history
Premature birth or an infant who is born with a low weight
Developmental delay

Causes

A lazy eye occurs when one eye is receiving less visual signals, rendering it the weaker eye. This leads to a lack of cooperation between the eyes and eventually the brain starts to suppress, or ignore, the visual input from the lazy eye.

There are different reasons why the lazy eye receives less visual signals and the most common ones are:

That the eyes are crossed, or misaligned, known medically as strabismus
Refractive reasons, which means it’s due to the patient’s optical prescription - this could either manifest as a lazy eye if the patient has very high nearsightedness or farsightedness or if one eye has a stronger prescription than the other so there is a significant difference in the prescription between both eyes
There is an obstruction that is preventing the lazy eye from receiving visual signals properly, for example a droopy eyelid (ptosis), cataracts, or corneal scarring.

Treatment

Various methods are used to treat amblyopia and often certain methods are combined to provide the most efficient way of ensuring healthy visual development. The optometrist will make sure that the child is wearing the proper prescription glasses and will correct any refractive error.

The optometrist will diagnose what is causing the child to have a lazy eye and will treat the root cause. For example, if there is something obstructing the eye, such as cataract, it will be referred to for immediate treatment.

Vision Therapy Treatment

It used to be accepted that the most effective way to treat a lazy eye is by patching the stronger eye which would force the brain to learn how to properly work with the weaker eye. We still use methods to lessen the effect of the stronger eye, either with an eye patch, virtual reality games that favor the weaker eye, or eye drops that cause temporary blurry vision in the stronger eye.

However, nowadays we understand the importance of adding some stepping stones to help the visual system transition from using one eye while the stronger eye has been blurred or patched to when the treatment is over and both eyes are open and must learn to work together. Many studies show that patching along with this vision therapy training of using both eyes together effectively is the most efficient approach.

Prevention

It usually is not possible to prevent a lazy eye or the possible underlying causes of this condition. The main proactive measure that can be taken is to make sure your children receive regular routine eye exams. The earlier a lazy eye is diagnosed, the more effective treatment tends to be. If your child has any risk factors for developing a lazy eye, please consult with our optometrist when and how often your child should have a more advanced developmental eye exam.

It is recommended that babies’ eyes are checked at around six months and then toddlers should be checked again between age 3 and 5.

Common Questions

At what age should I bring my child for an eye exam?

The American Optometric Association recommends that babies receive an eye exam at six months old and then toddlers at age three. After that, the child should go for an eye exam at least every two years, but the optometrist will recommend how frequent the routine eye exams should be, depending on the child’s family and medical history. Furthermore it is recommended that children entering into school should have a more thorough developmental eye exam to assess for aspects of the visual system that can impact learning and reading.

How does the optometrist diagnose a lazy eye?

The optometrist will perform a comprehensive eye exam which will include using eye drops to dilate the child’s pupils. During the eye exam the optometrist will check for: A wandering eye Poor vision in both eyes or a significant difference in vision between both eyes Eye health If the eye exam is being performed on an infant or a child who cannot speak, the optometrist will use a flashlight or other interesting targets to check if the child can focus on the target and follow it while it moves. If the child is able to speak, the optometrist will use pictures or letters to check for visual acuity.

Summary

A lazy eye occurs when the eyes are not properly working in sync, causing one eye to dominate while the other becomes weaker until the brain eventually ignores the visual input from the ‘lazy eye’. The good news is that there’s very good treatment options so it’s important to have your child checked for a lazy eye to ensure that the proper diagnosis and treatment can be provided. Please schedule an appointment at our office for your child’s developmental eye exam, especially if the child has risk factors for developing a lazy eye. If you notice anything unusual about your child’s vision or that one eye is wandering in or out, please make sure to come see the optometrist. Early detection of a lazy eye yields better treatment results so please don’t wait to book an appointment at our office.

Learn More

Strabismus Treatment in : Understanding Symptoms, Treatment, Causes, Diagnosis, and Prevention

Early detection and treatment of strabismus is important to prevent further visual problems and maintain good eye health.

Exotropia: Causes, Symptoms, Diagnosis, and Treatment Options

Exotropia is a type of strabismus where one eye turns outward. If you suspect that you may have exotropia, please see our optometrist for a treatment plan.

Understanding Accommodative Insufficiency: What It Is, Symptoms and Impact on Learning and Work

Accommodative insufficiency causes eyestrain and headaches when focusing on nearby objects. Visit our eye doctor for proper treatment.

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