Amblyopia

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Overcoming Amblyopia or the Lazy Eye

Amblyopia, commonly known as ‘Lazy eye’ is a vision-related disorder that commonly affects young children.

Let’s understand Amblyopia

In some children, only one of the two eyes focuses properly. This is a vision problem called lazy eye (medical term for this is Amblyopia). It is caused when the two eyes send different images to the brain. This may happen if one of the eyes is more nearsighted, farsighted or has more astigmatism ( refractive error) than the other, or if the child has a squint. The brain then primarily processes the information coming from the better eye, ignoring the other. If unnoticed or untreated, it can continue to affect in later years. It is estimated that about 4% of children and between 1-5% of the adult population is affected by this visual impairment.

To understand this condition better, let us see how one is able to 'see'.

Understanding Binocular Vision

Vision develops in the first few years of life as the brain starts interpreting visual signals coming from the eyes. What we ‘see’ results from signals sent from the eyes to the brain. Usually, the brain receives signals from both (bi) eyes (ocular) simultaneously. However, due to the placement of the eyes, the visual information collected by each eye differs slightly. If all is well, the brain can use these differences to coordinate eye movements and judge distances so that a wholesome meaningful 3D visual is created, and that is what we ‘see’.

What Causes Amblyopia/Lazy Eye?

A lazy eye may be an outcome of abnormal visual experiences in early life.

The eyes, visual pathways and brain centres are in constant development and maturation in the first few years of life. Occasionally, when one of the eyes does not function correctly, the brain tends to rely on the visual impulses coming from the stronger eye. If left untreated, the stronger eye continues to develop further and the weaker eye can worsen. This visual imbalance is known as Amblyopia.
Bynocs has been specifically developed to assist Ophthalmologists and Optometrists in accurate assessment and management of Binocular Vision anomalies through a range of software based activities.
Certain abnormalities in the eyes during the growing years and/or later life can cause an eye to develop a poor vision and result in Amblyopia, such as:

Refractive Errors and Anisometropia

Refractive error in an eye simply means that the eye cannot focus correctly, leading to near-sightedness, far-sightedness or astigmatism. Uncorrected refractive errors can put a strain on the eye muscles which have to work harder to achieve a focussed vision.
In some cases, both eyes have different magnitudes of refractive errors known medically as ‘Anisometropia’. One of the eyes may have a significantly poorer vision than the other. When this happens in one of the eyes, the brain tends to rely more on the sharp quality impulses coming from the normal eye and ignore the weaker eye.

Muscle Imbalance or Strabismus

Our eyes have a set of muscles that help with eye movements. A weakness in any eye muscle will lead to abnormalities in the movement such as turning inwards or outwards or having uncoordinated movements. The affected eye thus becomes ‘lazy’ and the brain learns to ignore the poor quality visual stimulus coming from the lazy eye.

Cataracts

A cataract is a condition that requires urgent attention to prevent long term damage. A cloudy lens i.e cataract may obscure vision in the eye and lead to the development of Amblyopia in the affected eye. Cataracts can occur in infancy as well as develop in later life.

What Are The Symptoms of Amblyopia/Lazy Eye?

Amblyopia can develop in childhood and may continue to persist in adulthood as well.

Symptoms in Children

When a child develops a lazy eye, parents may observe that their child has a difficulty in focusing on objects or they squint or shut one of the eyes so as to view the objects or surroundings clearly. Often, the child’s eyes may appear to turn inward, outward or they may not work together in coordination.

Older children may also complain of poor perception of depth, and an inability to view things clearly from a distance such as writing on the classroom board.

When children develop such symptoms, It is important to consult a pediatric ophthalmologist as soon as possible to enable early treatment.

Symptoms in Adults

If a child with lazy eyes does not receive early treatment, the condition may worsen further and continue to persist in adulthood as well. Sometimes, a child may be undiagnosed for visual disturbances at an early age and may receive a diagnosis at a later age when visual disturbances intensify.

The common complaints of adults having lazy eyes are:
  • Blurred or double vision
  • Uncoordinated eye movements
  • Poor depth perception
  • Squinting or closing one eye to view better
Childhood Amblyopia Adult Amblyopia
● The child may be seen squinting or shutting one eye.
● Parents may be able to see uncoordinated eye movements in their child.
● The child may complain of inability to view the classroom board clearly.
● Blurred or double vision
● Poor depth perception
● Increased complaints of eye strain.

How Is Amblyopia/Lazy Eye Treated?

If left untreated, a lazy eye may worsen and lead to permanent visual impairment. The goal of treatment is to help improve vision in the lazy eye and thereby optimize binocular vision.
The traditional treatment approaches to treat the lazy eye include:
When a lazy eye develops as a result of near-sightedness or far-sightedness or an unequal refractive error in both the eyes, corrective eyeglasses can help improve the vision and prevent further deterioration.

Eye-Glasses

Surgery

In severe cases such as cataracts, prompt surgery is essential to prevent loss of vision. Surgery may also be performed for strabismus (muscle weakness of the eyes) or to improve the refractive error

Patching or Overpowering the Normal Eye

Patching

Patching is the most commonly advised treatment for the lazy eye in children. In this, a small eye patch is applied to the normal eye in an attempt to obscure its vision for a few hours daily. This way, the brain is trained to recognize the visual impulses coming from the weaker eye.

Penalisation using Eye Drops

Eye drops are instilled into the normal eye and cause a temporary blurring of vision in the normal eye. This prompts the brain to turn towards visual impulses coming from the weaker or lazy eye.
However, the success of these approaches depends on how regularly the child is in applying the patches/eye drops. Most children do not like this kind of patching and tend to resist it. Very often, parents do not apply the patch to avoid social stigma.
Patching or penalisation can also lead to the development of visual problems in the normal eye and this approach is not helpful in correcting the adult lazy eye.

Limitations with Patching/Penalisation

  • Lesser success rates and higher incidence of residual visual deficit.
  • Prolonged treatment over many years is essential for optimal results.
  • Monocular treatment – treats one eye only.
  • Chances of visual disturbances occurring in the stronger eye.
  • Possibility of relapse once patching is discontinued.
  • Discomfort to the eyes and the child due to eye-drop installation or patching.
  • Patching may cause social anxiety in older children.
  • Non-compliance to patching due to peer pressure.
  • Time is of the essence, patching is not helpful unless started at an early age (<9years).
  • Not useful to treat Lazy Eye in adults.
While it is true that for treating the Lazy eye, time is of the essence, and most treatments are directed towards children; there are newer treatment technologies available that can be used to improve eyesight in adults and the elderly population as well.

“It is a myth that lazy eyes can be treated only in early childhood. Adults too can overcome their lazy eyes with recent advances in technology that helps achieve perfect vision.”

Dichoptic Eye Treatments

Treatment for eyes using dichoptic technology is an emerging and highly effective approach for correcting Lazy eyes and improving vision. Dichoptic eye treatments work by offering simultaneous and separate visual stimuli to both eyes. In simpler terms, depending on the impairment, both eyes are presented with different stimuli at the same time, which helps enhance the contrast difference perceived by both eyes. This can help achieve a balance between the normal eye and the lazy eye.

Dichoptic technology can help improve vision in children as well as adults.

Bynocs AmblyGo Therapy For Childhood and Adult Amblyopia/Lazy Eye

A newer age, revolutionary technology developed to overcome Amblyopia or lazy eye in both children as well as adults.

How Does Bynocs AmblyGo Work?

In severe cases such as cataracts, prompt surgery is essential to prevent loss of vision. Surgery may also be performed for strabismus (muscle weakness of the eyes) or to improve the refractive error
  • A detailed history is taken and a thorough eye examination is performed by the optometrist.
  • The eye condition is evaluated using a computerised diagnostic test on the patented Bynocs software.
  • Individual treatment plans are formulated after consultation with the ophthalmologist.
  • The Bynocs technology helps the brain to appreciate the images from the lazy eye, using a gaming interface and specialised eyewear. These exercises are targeted at the visual centres of the brain.
  • The interactive gaming interface makes the sessions fun to attend for children as well as adults.
  • Sessions last for 30 minutes each day and it is recommended to attend the sessions for 5 days a week.

With Bynocs AmblyGo, patients have experienced 80-90% improvement in their visual symptoms within just 6 weeks!

Bynocs AmblyGo: Advanced Yet Easy

Bynocs Ambly-Go is a simple and engaging eye treatment program that can be performed with minimal equipment. The initial evaluation is done at a Bynocs eye clinic. The treatment sessions can be undertaken either at the eye clinic or in the comfort of one’s home.
The only equipment needed to train on the patented Bynocs Ambly-Go is a computer with a stable internet connection and specialised Anaglyph glasses which are provided by Bynocs. The treatment sessions are carried out under optometrist guidance, available on a video call.
Lazy eye or the amblyopic eye is treatable and reversible. Newer treatment technologies like dichoptic eye treatment offer excellent vision improvements even in adults.
Contact your eye-care practitioner and regain control of your eyesight.

References

Blair K, Cibis G, Gulani AC. Amblyopia. [Updated 2020 Dec 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing;

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