Lazy eye, also known as amblyopia, is a condition where there is reduced vision in one or both eyes without any structural problems. It is generally observed in the population at a rate of 1-4%.
The visual system completes its development around the ages of 10-12, and if lazy eye is detected during childhood, it can be treated. However, if it is noticed after the age of 12, although there are various treatment methods available, the improvement in vision is limited.
What Causes Lazy Eye?
The causes of lazy eye are often conditions that can be prevented or reversed if detected in a timely manner. The most common conditions encountered in childhood that frequently lead to amblyopia are:
+ Uncorrected refractive errors, such as hyperopia and astigmatism, especially the need for glasses
+ Presence of more than 1.5 diopters of refractive error between the two eyes
+ Strabismus (crossed or misaligned eyes)
+ Conditions that obstruct vision, such as cataracts or drooping eyelids
How is Lazy Eye Treated?
If lazy eye is present in both eyes, treatment is usually successful by eliminating the primary causes.
Firstly, the underlying cause of amblyopia is addressed. If the cause is the need for glasses, regular use of glasses is ensured. If the cause is strabismus and it is not corrected with glasses, strabismus surgery may be performed. If there is a condition like drooping eyelids or cataracts that obstructs vision, it is treated, and the visual axis, known as the pupil, is cleared.
If vision improvement can be achieved with these treatments, the progress can be monitored accordingly.
If lazy eye is present in only one eye, it occurs as a result of the brain blocking the image from the weaker eye through the visual pathways when there is a significant difference in the level of vision between the two eyes. In such cases, if the difference in vision levels is substantial, the stronger eye needs to be patched or covered.
In a child wearing glasses, if vision cannot be improved in one eye despite the use of glasses, the duration of patching is determined by the child’s age and the difference in vision between the two eyes, as decided by an eye doctor. For example, in an 8-year-old child with lazy eye who can see 100% with one eye and 10-20% with the other eye, full-day patching may be required because the remaining years for achieving vision improvement are limited, and this treatment does not yield significant benefits after the age of 12-13. However, for a lazy eye patient with less disparity in vision levels and an earlier onset, 2-3 hours of patching per day may be sufficient. The goal of this treatment is to increase the vision level of the weaker eye. After the vision levels improve and become equal, patching treatment can be continued in a controlled manner for an additional period of 6 months to 1 year to prevent regression.
Patching the eye is particularly challenging for a child, especially if the vision level in the weaker eye is very low. It is essential for the family to accept the necessity of this treatment and support the child during the patching process. If patching cannot be accomplished despite all efforts, using certain eye drops that dilate the pupil to temporarily reduce the vision in the stronger eye can be beneficial, allowing the other eye to be used more and improve its vision. In cases where patching treatment is not feasible, digital occlusion glasses can be helpful, but they are suitable for use up to the age of 5-6.
In conclusion, if not treated in a timely manner, lazy eye can result in a permanent decrease in vision. It is crucial for every child to undergo a vision examination by an eye doctor around the age of 4-5, preferably before reaching school age.