Amblyopia (Lazy Eye)

Pediatric ophthalmologists at Riley at IU Health provide young children with medical and surgical treatment of eye conditions like amblyopia. Our ophthalmologists are board certified in ophthalmology and are committed to providing high-quality care in a child-friendly environment.

How Amblyopia Develops and the Importance of Early Diagnosis

To develop good eyesight, infants need both eyes to provide the same clear image to the brain. If the images differ, the brain tries to block the image from the weaker eye. This eye continues to be ignored and amblyopia develops if the problem is not corrected.

Amblyopia can result from any condition that prevents the eye from focusing clearly, such as misalignment of the eyes (strabismus), or a droopy eyelid or clouding of the front part of the eye (a cataract). Refractive error—a problem with the eye’s ability to focus caused by the shape of the eye—may also cause amblyopia. Refractive errors can include nearsightedness, farsightedness and astigmatism.

Early diagnosis of amblyopia is critical because the brain’s vision system is typically completed between the ages of 8 and 10. If amblyopia is not addressed in early childhood, problems such as poor vision, permanent visual defects and problems with depth perception can continue throughout life.

Early treatment can improve vision and deliver the best long-term outcome. Studies show that children age 7 and up are less responsive to treatment than those 3 to 6 years old. One recent study, however, suggests that children up to age 17 may benefit from treatment.

Three Types of Amblyopia:

• Strabismic amblyopia. The eyes are not straight and one eye may turn in, out, up or down with strabismic amblyopia. When the brain begins to ignore this weaker eye, vision loss occurs in the eye that is not straight.
• Deprivation amblyopia. When cataracts or similar conditions impair one or both eyes, deprivation amblyopia may develop. If not treated early, children with deprivation amblyopia may have very poor vision for life.
• Refractive amblyopia. This condition occurs when there is a big difference in the vision capabilities of each eye. The brain learns to rely on the vision of the stronger eye. Refractive amblyopia can be difficult to detect because there may be no noticeable difference between the two eyes. Children may not complain about blurry vision because the brain relies on images from the stronger eye. As a result, refractive amblyopia may only be detected after a vision screening that tests the capability of each eye. Refractive amblyopia can affect one or both eyes, and early diagnosis and treatment are important for optimal vision.

Symptoms That Suggest Amblyopia

Symptoms of amblyopia can vary. In many cases, neither the child nor the parent is aware of any symptoms. Amblyopia may be present if:

• Your child has poor overall vision or complains about blurriness in one eye
• There are obvious physical differences in the eyes, such as strabismus or misalignment of the eyes
• Your child squints with one eye, brings objects closer to see, has abnormal head posture or involuntary eye movements
• Your child has problems with depth perception
• There is a family history of amblyopia

Sometimes amblyopia is not detected until a vision screening is done. The U.S. Preventative Services Task Force recommends vision screening for all children by a pediatrician or primary care doctor at least once between the ages of 3 and 5.

Diagnosis of Amblyopia

Riley at IU Health pediatric ophthalmologists use a variety of diagnostic tests to detect amblyopia at various ages. Infants are checked for their ability to fix and follow objects with their eyes. An ophthalmologist can screen for strabismus and see how a baby reacts when one eye is covered.

Physicians may test toddlers’ pupillary red reflexes or conduct other tests to identify significant refractive errors like nearsightedness, farsightedness and astigmatism. Once children can read or match objects, they can complete a vision screening to test the acuity of each eye.

An ophthalmologist examines the inside of your child’s eye to look for diseases or conditions like cataract inflammation (swelling) or tumors.