Lazy Eye and Vision Therapy

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A lazy eye is the result of an underdeveloped visual system and vision therapy offers an effective treatment plan to strengthen the entire visual system to work together properly as a team.

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What is a lazy eye?

When a person has a lazy eye it means that there’s a decrease in vision in one eye and it’s not attributed to a disease, but rather to a lack of proper development of the visual system but rather to a lack of proper development of the visual system. A lazy eye, known medically as amblyopia, almost always manifests in one eye, while the other eye dominates and is relied on for good vision, however there are rare cases where both eyes could have amblyopia.

Patching

When there is a lazy eye, the visual system relies on the stronger eye and the brain ignores the visual input from the lazy eye, referred to as suppression. In order to strengthen the lazy eye, the accepted method for many years has been to use patching or special eye drops, referred to medically as occlusion therapy. The strategy is to shut off the visual ability of the strong eye in order to force the lazy eye to step up and strengthen it’s visual abilities.

Challenges of Patching

The patching method is logical and it directly targets treating the issue at hand by forcing the weak eye to strengthen. However, that being said, practically speaking there are certain challenges with this method. The main problem reported with patching is the issue of compliance. Many children do not want to walk around with a patch on their eye and can be bullied as it draws attention to an unusual appearance of wearing an eye patch. Moreover, the eye that they’re covering is the one that they depend on to see so they don’t want to cover it. A solution to these issues is to use an eye drop in the strong eye which then blurs the vision only in this eye, forcing the lazy eye to strengthen. However, these eye drops are medicated and come with drawbacks, including side effects such as light sensitivity and disorientation.

Once the patient finishes using occlusion therapy, there is another challenge that arises. The visual system has been used to having only one eye open and now it needs to relearn how to work together as a team with the brain working with both eyes. If you try covering one of your eyes for a few minutes, it takes a bit of readjusting to get used to looking with both eyes open again. Imagine this kind of adjustment for a person who is so used to only using one eye for so long. They went from only seeing from the dominant eye as they had a lazy eye which was suppressed and then the strong eye got covered, forcing the weak eye to strengthen on its own.

Additionally, it is thought that age is a contraindication for occlusion therapy, meaning that occlusion therapy is much less effective at an older age. However, there is research that supports that incorporating patching along with vision therapy yields successful results, no matter what age the patient is.

The approach using vision therapy is to incorporate eye patching along with various visual activities which strengthen the visual system as a whole, training the brain to work with both eyes together as a team.

Vision Therapy’s Role in Treating a Lazy Eye

Vision therapy uses a treatment approach which combines various methods in order to maximize the benefits that each has to offer. Vision therapy customizes each treatment plan to the individual patient’s needs and visual skills. A comprehensive eye exam is performed to understand the underlying cause of the amblyopia and the extent of the patient’s visual abilities. During therapy sessions, the patient will engage in various visual activities that have the purpose of training both eyes to work properly with the brain.

Binocularity

Our visual system consists of two eyes and therefore, visual skills cannot only be isolated as being considered for each eye individually, but rather it is also important to consider the strength of the visual skill when both eyes work together.

This applies to amblyopia because when treating a lazy eye, indeed it is important to strengthen the weaker eye so that the brain won’t keep suppressing it. However, if we end treatment there, then we are stopping short, only treating the lazy eye isolated on its own without training it to adjust to working alongside the other eye as part of a visual system.

This is where vision therapy becomes so essential. The treatment approach with vision therapy generally includes a form of occlusion (patching, drops, or virtual reality) in addition to training both eyes how to work together in order to achieve healthy binocularity.

Possible Treatment Tools

The treatment plan may include any of the following, often it’s a combination:

Glasses or contact lenses
Patching or blurring the strong eye using eye drops or virtual reality glasses
Visual activities to develop binocularity skills such as:
- Accommodation (the ability to focus up close)
- Eye tracking movements
- Eye-hand coordination
- Motor skills
- Visual spatial judgement
- Depth perception
- Reduce suppression of the lazy eye

There are all sorts of creative ways to incorporate these skills into various educational activities.

Common Questions

What is vision therapy and how does it relate to a lazy eye?

Vision therapy is an approach to treatment based on the fundamentals of developmental optometry. We are not born with all the necessary visual skills to achieve a high quality of life. Visual skills are developed and learnt over time, mostly during childhood. Sometimes people require assistance in developing all sorts of life skills and visual skills are no different. Vision therapy’s approach to vision is so much more than 20/20 vision. It focuses on our entire visual system and how our brain works with both eyes together to be the strongest team it can be. By using various visual activities, we can train our brain and eyes to work together properly and to develop the visual skills we need to function in our daily life. If someone has a lazy eye, one eye is dominant and the other eye is weaker, nicknamed as the ‘lazy eye’. Vision therapy ends the competition between both eyes, of having one eye being the stronger one while the other trails behind as the weaker one. This treatment trains both eyes to work together with the brain to optimize the visual system.

What are the risk factors of having a lazy eye?

Family history of amblyopia Premature birth Born at a small size Developmental delay It is estimated that 3% of children have lazy eye/amblyopia.

What is a vision therapist?

To put it simply, a vision therapist is a person under the supervision of an optometrist who conducts therapeutic activities to help a person who suffers from a visual disorder.

Summary

If you or a loved one have a lazy eye or you have a risk factor for amblyopia, such as having a family history or a premature birth, please schedule an appointment for a developmental eye exam at our office. Our staff have extensive experience diagnosing and effectively treating a lazy eye. To schedule a developmental eye exam, please call (212) 752-6930. Patients with developmental vision issues visit our clinic from all over New York, and we are proud to be a leading provider of developmental vision services for patients from New York, Queens, Brooklyn, and Long Island.

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Testimonials

At Amplify with Dr Wernick I was seeking help for seemingly intractable, probably age-related dryness. I've seen other doctors about it, and that has been helpful, but what he explained to me about it and the careful way he answered all my questions gave me so much more of a clear understanding of what is going on (and is not) that I am more able to implement all his and others' recommendations than I was before. And he gave me additional resources for further follow-up. I am most grateful.

Cynthia Norton

Wow! This is a great Eye Care medical facility. I was thoroughly examined by Dr. Pinkhasov for over 2 hours. She made sure to check my eyes for pretty much everything and patiently explained proper care for my eyes. They definitely know how to provide great care and treat their patients right. Now I know why they have such a great reputation and been around for so long.

Steve Fay

Dr. Kavner is a gifted diagnostician and orthoptic therapist. He treated me several decades ago for a condition similar to dyslexia. I was having migraines five times per week. I worked with him for about a year and I experienced tremendous improvement (down to 3-4 per year) that has lasted.

Mary K.

Dr. Kavner recommended two types of eye therapy for my daughter. One of them using bio-feedback. In just three sessions she is seeing considerably better. She shouted this morning: Ooh my God! I could not see these letters with my glasses on, and now I can see them without my glasses. If you are willing and able to invest in improving your vision, this is a good place to go to!

Peter G.

Dr. Kavner recommended two types of eye therapy for my daughter. One of them using bio-feedback. In just three sessions she is seeing considerably better. She shouted this morning: Ooh my God! I could not see these letters with my glasses on, and now I can see them without my glasses. If you are willing and able to invest in improving your vision, this is a good place to go to!

Kinkie F.

I have always found Dr Kavner's work, expertise and wisdom of the highest caliber. As one of the fathers of OT, occupational othomology, his depth and breadth of knowledge about the eyes' health and wellbeing of the patient is exemplary. Cannot say enough good things about him.