Lazy Eye Treatment

How to Fix Lazy Eye or Amblyopia - A Brief History - 900 A.D. to Present

by Susan R. Barry, Ph.D., professor of neurobiology in Biological Sciences at Mount Holyoke College and the author of Fixing My Gaze (June, 2009) and Rachel Cooper of Optometrists Network

Lazy Eye Treatment with Eye Patches - 900 A.D. to Present

Documented treatment methods on how to fix a lazy eye or amblyopia dates back to about 900 A.D. At that time, Thabit Ibn Qurrah of Mesopotamia wrote that lazy eye (amblyopia) due to strabismus (misaligned eyes) should be treated by eye patching (occluding or occlusion of) the "normal eye". From the beginning, it was believed that the blocking or occlusion of the "normal" or "good eye" would force the use of the so-called "lazy eye", and therefore improve its vision. George Louis Leclerc, Count de Buffon (1743) was later given credit for the use of eye patching to treat amblyopia (the medical term for lazy eye). In the 20th century, eye doctors throughout the world depended heavily on the use of eye patches for lazy eye treatment and the amblypopia eye patch was prescribed for many hours per day. In the 21st century -- to the great relief of many parents and their children -- scientific research proved that two hours of eye patching per day with one hour of near visual activities as eye exercises is just as effective as six hours of patching per day.

Lazy Eye Treatment with Eye Muscle Exercises or Orthoptics - 19th Century to Present

In the nineteenth century, eye muscle exercises called orthoptics were employed with or without eye patching to fix a lazy eye, but this treatment was little known and seldom made available to the general public. Today, there are still a small number of orthoptists practicing eye muscle exercises (convergence, etc.) internationally. The practice of orthoptics, however, has remained extremely limited in its scope by (1) focusing on eye exercises for the eye muscles only (convergence) and (2) mostly treating only one type of patient...children after strabismus surgery (post op). In addition, the field of orthoptics has fallen behind the changing times by focusing almmost exclusively on eye muscle exercises and excluding 21st century discoveries on lazy eye treatment and the human brain (neuroplasticity). Lazy Eye or amblyopia is a neurological condition, so treatment that addresses the eye muscles only is not effective.

Eye Treatments with Drugs (Eye Drops) - from Cleopatra to the Present

In the 20th century, drugs became an alternative to eye patches for lazy eye treatment when the use of atropine eye drops was adopted as a new way of blocking the vision of the "good eye". The atropine eye drops blur the vision in the "good eye" instead of covering it with an eye patch. The blurring of the "good eye" stimulates the brain to make greater use of the image coming from the lazy eye.

Atropine was first synthesized in a laboratory by German chemist Richard Willstètter in 1901, however plant extracts of atropine (eye drops made from deadly nightshade and other plants) were used by Cleopatria for cosmetic eye dilation in the last century B.C.

21st century scientific research has compared the use of eye drops to eye patches and has determined that these lazy eye treatment alternatives are equal in effectiveness. The choice between these comparable lazy eye treatments is up to the parent or the patient. Note, however, that doing at least one hour per day of near visual activities with either eye patches or eye drops is more effective than doing either of these lazy eye treatments on their own. In addition, remember that both of these treatment methods are directed only toward stimulating the use of the lazy eye. Therefore, these lazy eye treatments are incomplete because they do not stimulate normal coordinated two-eyed vision (binocular vision).

Lazy Eye Treatment - Not Much Changed until the 20th Century!

Lazy eye treatment and correction methods really did not change much until the twentieth century. Most likely, the reason that treatment changed so little is because lazy eye is a neurological condition - the vision problem occurs in the brain - and very little was known about the brain or how to help it change or recover until the late twentieth century.

Lazy Eye Treatment with Drugs (Eye Drops) Instead of or with Eye Patches -- from Cleop

In the last half of the twentieth century, pioneering doctors of optometry (e.g., Frederick Brock, AM Skeffington, Larry MacDonald, William M. Ludlam, Harry Wachs, Martin Birnbaum, Donald Getz, Robert Sanet, etc.) knowing full well that lazy eye happens in the brain, not the eye, went far beyond the basic eye muscle exercises of orthoptics to develop Optometry Vision Therapy. Incorporating new knowledge related to the human brain, Optometric vision therapy offers therapeutic visual activities with or without lenses or occlusion to treat all aspects of vision impacted by lazy eye or amblyopia. With Vision Therapy, for example, the patient engages in visual activities that require the simultaneous use of both the lazy eye and unaffected eye at all distances (near, middle and far range). Optometric Vision Therapy is now available to the public in some optometric clinics and private practices in the United States, Spain, Mexico, Canada, India and other countries as well.

In the 21st century, we are seeing a remarkable increase in mainstream scientific studies that investigate the methods and results of existing treatments for lazy eye. These studies examine (1) the necessary frequency and length of time for effective occlusion (eye patching or atropine drops), (2) the importance of visual activities with or without occlusion and (3) the maximum age at which treatment can still be effective. Despite many new and unexpected scientific discoveries regarding plasticity of the human brain and/or updated treatment protocols for lazy eye, the "old school" treatment methods persist and are slow to change. Eye patches or atropine drops alone are still the most common treatments for lazy eye. And, notably, older children and adults are still being told that it is too late to be successfully treated. For more articles on this topic, see:

References:

Treatment of amblyopia dates back to about 900 A.D.
Von Noorden GK. 1996. Binocular Vision and Ocular Motility. New York: Mosby, Inc. pp. 512-513.

In the last half of the twentieth century, pioneering doctors of optometry (e.g., Frederick Brock, AM Skeffington, Larry MacDonald, William M. Ludlam, Harry Wachs, Martin Birnbaum, Donald Getz, Robert Sanet, etc.) knowing that lazy eye happens in the brain…
Am J Optom Physiol Opt. 1977 May;54(5):269-75. Success in ambylopia therapy as a function of age: a literature Brief History. Birnbaum MH, Koslowe K, Sanet R.

The care of amblyopia in the four to ten year old child, William M. Ludlam Child and Adolescent Social Work Journal Volume 10, Number 5 (1993), 417-430, DOI: 10.1007/BF00844679

Optometric vision therapy offers therapeutic visual activities with or without lenses or occlusion to treat all aspects of vision impacted by lazy eye or amblyopia.
Hess RF, Mansouri B, Thompson B. A binocular approach to treating amblyopia: antisuppression therapy. Optom Vis Sci. 2010 Sep;87(9):697-704. In the 21st century, we are seeing a remarkable increase in mainstream scientific studies that investigate the methods and results of existing treatments for lazy eye. Levi DM. 2005. Perceptual learning in adults with amblyopia: A reevaluation of critical periods in human vision. Developmental Psychobiology 46: 222-232.