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How to Fix a Lazy Eye in Adults|Amblyopia in Adults

How to Fix a Lazy Eye in Adults

What is lazy eye/Amblyopia

How to Fix a Lazy Eye in Adults| Lazy eye is a condition in which one or both eyes have decreased vision caused by visual deprivation or abnormal binocular fusion.

The lazy eye develops in early childhood; hence it is a disease of childhood. Once a lazy eye has developed it becomes almost impossible to reverse the condition in some cases, while timely recognition of the lazy eye by the parents of the child can give a good prognosis for the vision.

As no organic cause can be determined by the examination, that is the reason why lazy eye disease remains undetected until late. There are some therapeutic procedures when followed in children can result in the best visual results. However, compliance is a keep factor for the best results.

As the process of normalization is prolonged, many patients do not keep compliance which is a key factor in a poor outcome. Education of the parents is very important who is having a child with lazy eye or amblyopia.

According to research, lazy eye affects up to 1 in 33 of the population this means up to 10 million people in the USA may have a lazy eye

Classification of Lazy eye:

The causes of amblyopia can be divided as followed

Stimulus deprivation amblyopia:

One of the most common causes of stimulus deprivation is congenital cataract, especially unilateral cataract that is highly amblyogenic. Other common cause includes drooping of the upper lid up to the eye’s visual axis.

Constant occlusion of one eye (> 1 week per year of age) due to any cause is very likely to develop amblyopia.

Refractive error:

Anisometropic amblyopia:

This condition arises when the refractive power between the two eyes is >1D. This is a highly amblyogenic stimulus.

Ametropic amblyopia:

When the symmetrical refractive error is >+5.0 DS or > -10.0 DS unilateral amblyopia may occur if correction is not done.

Astigmatic/ meridional amblyopia:

The relative risk of astigmatic amblyopic is increased if cylinder power is > 0.75 DC. Risk is more when there is a difference in axis or if the magnitude between two eyes is different.

Strabismic amblyopia:

Strabismic amblyopia is caused when one eye is preferred for fixation. If the process is alternating between the two eyes, then the risk is low.

Pathophysiology of Lazy Eye:

Retina:

There is a reduction in the spatial resolving power of the retinal cells.

Lateral geniculate nucleus:

In the lazy eye, there is a reduction number of cells in all the six layers of the lateral geniculate nucleus.

Visual cortex:

There is a reduction in the number of cortical cells.

Clinical Features of Lazy eye:

  1. Decreased visual acuity of two more lines on the Snellen chart.
  2. Crowding phenomenon.

There is an abnormality of contour interaction between the point of fixation and the adjacent objects. Visual acuity is better for single optotypes than multiple optotypes.

  • Normal ocular examination.
  • Decreased contrast sensitivity.
  • Binocular suppression of amblyopic eye.

MANAGEMENT OF LAZY EYE:

Exclude other causes:

Other causes of decreased vision such as refractive error, cataract, and tumors should be excluded.

Remove obstacles to clear vision:

Remove refractive error and perform cataract surgery for cataracts.

How Long Does it Take to Fixing a Lazy Eye With an Eye Patch

Occlusion therapy (GOLD STANDARD):

Patching Therapy for ambalyopia

The amount of occlusion therapy for lazy eye depends on the age, severity, and cause of lazy eye.

Steps:

  • Patching should be started as soon lazy eye is detected.
  • For part-time occlusion, it depends on the age of the patient. 1 hour/day for each year of age.
  • Full-time occlusion should not exceed 1 week per year of age.
  • Patching should be continued for 3-6 months.
  • If there is no progress for consecutive 3 months, patching should be considered a failure.
  • Patching should be maintained up to the age of 9 years, which is labeled as the age of the matured visual system.
  • Penalization.

This method is preserved for non-compliant or patients who show a failure to patching therapy or lazy eye

Pharmacological:

1% atropine drop is placed in the better eye to blur the vision for near.

Optical:

Image degradation is made in the better eye so that amblyopic has a competitive advantage.

In this method under correction, a better eye is made with optical lenses.

ADDITIONAL MANAGEMENT PRINCIPLES:

  1. Strabismic amblyopia:
  2. Occlusion therapy should be started before strabismus surgery. It is done because the fixation behavior will be harder to determine once the strabismic correction is made.
  3. Parent motivation towards patching is increased by the visual reminder of strabismus.
  4. Amblyopia due to refractive error.
  5. Refractive correction is made before patching therapy.
  6. Part-time occlusion is preferable if binocular interaction is present, amblyopia is mild and the child is in school.
  7. Stimulus deprivation amblyopia.
  8. Remove any barrier within the first 6 weeks of life.

PREVENTION:

  1. Awareness and education of the primary care physician.
  2. Vision screening programs in all communities.
  3. The red reflex of every baby should be checked at birth.

Can a lazy eye be fixed

Amblyopia can be reversed up to the age of 7-8 years, after this age it is usually permanent. It is the average age for the development of normal vision in the human eye, after this, no therapy or treatment can reverse the vision.

Signs of lazy eye

The signs of lazy eye/amblyopia include

  • Trouble seeing near or distant target
  • Inward or outward deviation of the eye
  • Head tilting

At what age does a lazy eye/amblyopia develop

Up to 6 years of age children are vulnerable to develop amblyopia.

What if there is no response after 3 months of Patching therapy for children

If there is no improvement after 3 months, then consider the following

  • Wrong diagnosis
  • Noncompliance
  • Uncorrected refractive error
  • Failure to prescribe specific treatment
  • Irreversible amblyopia

How to fix a lazy eye | Treatment for lazy eye

In children below the age of 9 years, patching therapy is considered a gold standard. It will force the lazy eye to do it function more effectively while the patch is placed on the better eye.

Lazy Eye Training

Games / activities designed to challenge the weak eye have proven to be very beneficial, but they are not enough as a single tratment to cure vision.

Lazy eye training tools include certain types of computer or iPad games and activities such as jigsaw puzzles and drawing pictures.

Training with computer games and videos to be effective in several small studies, one in 2016 and one in 2018. However, before it can be considered effective enough to be used without other forms of treatment, more research is needed, such as wearing an eyepatch.

Lazy Eyetraining

Can lazy eye worse

If left untreated the lazy eye may get worse over time. The brain gradually stops picking signals from the lazy eye and it can render a blind eye.

How to fix a lazy eye in adults

Until now there is no treatment option for the fixing of lazy eye in adults. The only possibility that can be provided is the optical correction to the best of its level.

But some optometrists say It is possible for adults to be treated for lazy eye via vision therapy.

Fixing lazy eye in adults

What is Vision Therapy

Through a series of progressive therapeutic eye exercises, patients develop visual skills. Visual enhancement is achieved by improving the communication between your brain and eyes.

Vision therapy is the aims to improve a person’s visual abilities. Vision therapy is performed once per week under the supervision of an eye doctor in sessions lasting 30-45 minutes. uses a variety of ways – such as testing, eye exercises, occlusion (patching) prisms and lenses to treat a visual problems.

Home exercises are given in the office to reinforce the exercises learned during the therapy session. For best results, commitment to weekly sessions and therapy homework assignments is essential. Through vision therapy, both eyes will be trained to work together to achieve clear and comfortable vision.

Some vision therapy programs to treat lazy eye may include:

  • Accommodation (focusing)
  • Fixation (visual gaze)
  • Saccades (switching eye focus, “eye jumps”)
  • Pursuits (eye tracking)
  • Spatial skills (eye-hand coordination)
  • Stereopsis (3-D vision)

Take Away

Lazy eye / Amblyopia, affects 3 out of every 100 children. The condition is treatable and usually responds well to strategies such as eye patching and corrective lens wear.

Lazy eye is something that can be avoided only by having a check-up with a pediatric ophthalmologist at an early age. The best results for a lazy eye are usually seen when the condition is treated early, in children 7 years of age or younger.

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