Amblyopia is a loss of vision, or poor vision, in an eye that did not develop correctly in early childhood. Amblyopia is also called lazy eye because one eye (the amblyopic eye) has weaker vision than the other. While amblyopia most often affects one eye, it can occur in both. This eye condition affects approximately two to three out of every 100 children and is the most common cause of pediatric vision loss.
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.
Improved vision is the goal of ophthalmologic treatment. Some children do not achieve 20/20 vision, but they can significantly improve their eyesight if diagnosed and treated early. The best time to treat amblyopia is infancy and early childhood.
The most common types of treatment for amblyopia are:
- Patches. During this treatment, your child wears an adhesive eye patch over the stronger eye for weeks or months. This forces him or her to use the weaker eye, which strengthens this eye and helps develop the part of the brain that works with vision. The patch may be worn daily for two to six hours. Older children who want a less noticeable option may use a Bangerter filter over an eyeglass lens of the non-amblyopic eye.
- Atropine eye drops. This treatment option places eye drops in the stronger eye to blur vision, causing your child to rely on the eye with amblyopia. Some families find using eye drops easier than using the eye patch because there is no need to worry about the child refusing or removing the patch. Eye drops do not work as well when the stronger eye is nearsighted.
- Surgery. The ophthalmologist may first need to treat the issue(s) causing the amblyopia. For example, a cataract can be removed from the eye or surgery can be performed to fix droopy eyelids. These options can help the eyes begin to work together. Surgery for these underlying conditions will not improve vision for those with amblyopia.
Treatment usually lasts until vision is normal or stops getting better. In most children, this may last several weeks, but in a few cases, patching can be necessary for years.
Children with amblyopia may wear glasses and contacts before and after treatment. These corrective measures will not fix amblyopia, but consistent use can improve overall vision and can be worn by children as young as one week old. Children can choose glasses and be fitted for contacts at our full-service optical shop.
Treatment for amblyopia may not significantly improve vision for some children. For those with good vision in one eye, safety glasses or sports goggles can protect the normal eye. If the normal eye stays healthy, children can function and enjoy all normal activities.
Points to Remember
Points to Remember
- Amblyopia, often called lazy eye, is the most common cause of vision loss in children.
- Amblyopia can occur in one or both eyes and can be caused by any condition that prevents the eye from focusing clearly.
- Parents, and even children themselves, may not detect amblyopia.
- Ophthalmologists test for amblyopia in infants and children using a variety of diagnostic tools.
- Early detection and vision screening are important because the parts of the brain that control vision are developed early in life.
- The best time to treat amblyopia is infancy and early childhood. Patching and eye drops are the most commonly prescribed treatments.
Support Services & Resources
Support Services & Resources
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
This National Institutes of Health website offers information and links related to health conditions, including amblyopia.
This website is supported through the American Academy of Family Physicians and has public information for conditions such as amblyopia.
The NEI, which is part of the National Institutes of Health (NIH), conducts and supports research, provides training, and shares health information about eyesight, eye diseases and conditions like amblyopia (lazy eye).
The American Academy of Ophthalmology is the largest national membership association of physicians who provide eye care in the United States. Their website contains information for parents about diagnosis and treatment of amblyopia.
In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.