Lazy Eyes and the Doctors Who Enable Them

I have written about amblyopia (often referred to as lazy-eye) before on this blog as well as in my new book, A Parent Guide to Strabismus, Eye Muscle Surgery and Vision Therapy. It’s time for a quick update here. The medical community has insisted, beyond much clinical and research-based evidence, that amblyopia cannot be improved after the age of seven. The reason for this long held mistaken belief and the subsequent flawed advice that results is the knowledge that amblyopia cannot occur after the age of seven. Somehow this was turned into the confused notion that amblyopia could not be treated after age seven. This same belief system holds that amblyopia is an eye problem. Amblyopia is not an eye problem - just one reason the epithet lazy-eye is completely unsound.

According to a soon-to-be-published article: Stereopsis and amblyopia: A mini-review by Levi, Knill and Bavelier,

“Amblyopia is a neuro-developmental disorder of the visual cortex that arises from abnormal visual experience early in life. Amblyopia is clinically important because it is a major cause of vision loss in infants and young children. Amblyopia is also of basic interest because it reflects the neural impairment that occurs when normal visual development is disrupted. Amblyopia provides an ideal model for understanding when and how brain plasticity may be harnessed for recovery of function…Impaired stereoscopic depth perception is the most common deficit associated with amblyopia under ordinary (binocular) viewing conditions (Webber & Wood, 2005). Our review of the extant literature suggests that this impairment may have a substantial impact on visuomotor tasks, difficulties in playing sports in children and locomoting safely in older adults. Furthermore, impaired stereopsis may also limit career options for amblyopes.”

Amblyopia occurs in the brain, not the eye. It is treatable at any age. Behavioral optometry has known all of this since the 1930s. Behavioral optometrists have been successfully treating amblyopia with vision therapy all this time despite aggressive and unyielding resistance from the medical community. Since our patients are unaware of the so-called science, they continue to see positive results from vision therapy - at just about any age.

Dr. Susan Barry, Professor of Biology and Neuroscience at Mount Holyoke College and author of Fixing My Gaze: A Scientist’s Journey into Seeing in Three Dimensions, wrote a review of the above article:

“This paper by Levi and colleagues challenges 2 assumptions that have persisted in the medical literature for the past 2 centuries. The first is that the principle deficit in amblyopia is reduced visual acuity in the affected eye so that the optimal treatment is occlusion of the non-amblyopic eye. However, current research suggests that amblyopia results from poor binocular cooperation between the 2 eyes, leading not only to reduced visual acuity in the affected eye but also to reduced or absent stereopsis [the ability to see in 3-D]. Accordingly, the authors reviewed the impact of amblyopia on stereopsis and the consequences of reduced or absent stereopsis on visuomotor skills, career opportunities, and self-image. Occlusion therapy, even if it results in enhanced visual acuity in the amblyopic eye, produces only modest improvements in stereopsis.

Treatment for amblyopia has traditionally been applied only to children because it was generally assumed that the visual system is malleable only during a critical period in early childhood. However, as the authors point out, a large degree of plasticity in the very young brain does not imply that plasticity comes to an end after childhood. Indeed, the authors review 21 experimental treatments involving 259 subjects, mostly adults… Across all treatments, 55% of anisometropic amblyopes and 26% of strabismic amblyopes showed substantial improvement in stereoacuity after training…In summary, Levi and colleagues provide evidence that amblyopia can be treated in adulthood. Limited recovery from amblyopia to date may result from the narrow scope of treatments standardly available and an overly pessimistic view of adult visual plasticity.”

Don’t let lazy doctors - who continue to rely on outdated opinions - talk you out of trying to reverse your amblyopia with vision therapy after age seven, or talk you into dangerous surgeries claiming to fix amblyopia before age seven. These opinions were never based on actual facts in the first place. Be sure to check with a behavioral optometrist before making any decision about your or your child’s vision.