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When should you see a doctor?

Amblyopia, better known as lazy eye or wandering eye, affects between two and five percent of children in the United States. If you suspect your child is developing a lazy eye, what should you do?

“Fortunately, amblyopia is very treatable in young children,” said Dr. Collin Hair, a pediatric ophthalmologist at Geisinger. “But it is important to seek treatment early, as the condition can lead to significant damage, and even blindness, if it isn’t treated.”

Here’s what you need to know about the diagnosis and treatment of lazy eye.

Why the eye wanders
Lazy eye happens when your child’s brain only absorbs images and signals sent by one eye. This is caused by a change in the nerve pathways between your retina and the brain, often because of an abnormal visual experience like cataracts or eye misalignment.  

“The eye that is being ‘ignored’ doesn’t develop at the same rate,” said Dr. Hair, “and this lack of use can cause the condition to worsen. Developing eyes are ‘use it, or lose it.’”

Risk factors for a lazy eye include premature birth, small size at birth, family history of eye issues and developmental delay. The types of amblyopia are characterized by the underlying cause of the condition, including:

  • Eye Misalignment (strabismus): This is the most common cause of lazy eye. Children can be born with or develop eyes that cross in, drift out or have other abnormal movements. This prevents them from tracking in unison and over time, this difference will continue to weaken the vision of the turned eye. These problems can follow children into adulthood. 
  • Dramatic difference in sharpness (refractive amblyopia): If one of your child’s eyes has a high prescription and the other does not, the eye that is constantly blurred will suffer and may cause a lazy eye. This can be from high near or far sightedness or even astigmatism. 
  • Deprivation: When a child is born with a medical condition like cataracts or droopy eyelids in one eye, it can prevent light from entering the eye; this can prevent the eye from developing normally. These conditions need to be quickly treated to prevent permanent vision loss.


Early detection and long-term effects

Beyond the telltale signs of lazy eye, you may notice your child struggling with depth perception, squinting or rubbing one eye. To confirm the diagnosis, you should schedule a vision screening with your optometrist or pediatrician. 

“Many pediatricians now screen for these problems with a test called photoscreening,” said Dr. Hair. “It estimates the child’s prescription and eye alignment, looking for potential problems.” Many schools also use this as part of their annual testing.

If caught early, lazy eyes can be treated in several different ways. However, patients should have a treatment plan laid out as early as possible, when the condition is easiest to treat. Older school-aged children are able to receive treatment, but it may require more time to improve. Nearly 3 percent of adults experience permanent loss of vision as a result of untreated lazy eyes.

Treatment options for lazy eye
“Our treatments are designed to strengthen your child’s vision in the poorly seeing eye by forcing the brain to use it,” said Dr. Hair. “It’s just like exercising a weak muscle.”

The mainstay of amblyopia treatment is patch therapy, which covers the stronger eye. This is done only after correcting any significant refractive error (or need for glasses). Sometimes, eye drop medications such as atropine can treat amblyopia. Surgery to realign the eyes, or eye muscle surgery, can be very helpful when done early to restore the eyes’ ability to work together. 

Untreated lazy eyes are a common cause of blindness. However, the good news is that treatment is readily available and almost always successful. If you are concerned your child has an eye condition, Geisinger’s pediatric ophthalmology specialists have extensive training in evaluating and treating eye disorders, including complex conditions that require eye surgery. They also provide comprehensive eye care for all vision problems, such as prescribing eyeglasses and contact lenses. 

Collin Hair, MD, is a fellowship-trained pediatric ophthalmology and strabismus specialist who provides ophthalmology care for infants and children with a wide range of eye diseases and disorders. He sees patients in Geisinger’s Forty Fort and Wilkes-Barre clinics. To schedule an appointment or for more information, call 800-332-8901.

Child receiving an eye exam
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