Amblyopia Health Article

Definition

Amblyopia refers to diminished vision in either one or both eyes, for which no cause can be discovered upon examination of the eye. Amblyopia is the medical term used when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. This condition is also sometimes called lazy eye.

Description

Lazy eye is a common non-medical term used to describe amblyopia because the eye with poorer vision does not seem to be doing its job of seeing. Amblyopia is the most common cause of impaired vision in childhood. It affects approximately two or three out of every 100 children. Vision is a combination of the clarity of the images of the eyes (visual acuity) and the processing of those images by the brain. If the images produced by the two eyes are substantially different, the brain may not be able to fuse the images. Instead of seeing two different images or double vision (diplopia), the brain suppresses the blurrier image. This suppression can lead to amblyopia. During the first few years of life, preferring one eye over the other may lead to poor visual development in the blurrier eye. Unless it is treated successfully in early childhood, amblyopia usually persists into adulthood and is the most frequent cause of monocular (one eye) visual impairment among children.

Demographics

The prevalence of amblyopia is difficult to assess, with estimates ranging from 1.0 to 3.5 percent in healthy children to 4.0 to 5.3 percent in children with other vision problems. It is seen in similar numbers in both sexes and in all races.

Causes and symptoms

Amblyopia may be caused by any condition that adversely affects normal visual development or use of the eyes. All babies are born with poor eyesight. As babies grow, however, their eyesight usually progresses. Good eyesight needs a clear, focused image that is the same in both eyes. If the image is not clear in one eye, or if the image is not the same in both eyes, the vision pathways will not develop as they should. In fact, the pathways may actually worsen. Anything that blurs the vision or causes the eyes to be crossed during childhood may cause amblyopia. Some of the major causes of amblyopia are as follows:

• Strabismus. A misalignment of the eyes is the most common cause of functional amblyopia. The two eyes are looking in two different directions at the same time. The eyes may turn in, out, up, or down. Strabismus may be diagnosed at birth, or it may develop later in childhood. The brain is sent two different images and this creates confusion. Images from the misaligned or "crossed" eye are turned off to avoid double vision.
• Anisometropia. A difference of refractive states exists between the two eyes (in other words, a difference in prescription between the two eyes). For example, one eye may be more nearsighted than the other eye, or one eye may be farsighted and the other eye nearsighted. Because the brain cannot fuse the two images, the brain suppresses the blurrier image, causing the eye to become amblyopic.
• Cataract. Clouding of the lens of the eye causes the image to be blurrier than the other eye. The brain prefers the clearer image, and the eye with the cataract may become amblyopic.
• Ptosis. If light cannot enter the eye because of the drooping lid, the eye is essentially going unused, which can lead to amblyopia. However, ptosis is rarely related to the development of amblyopia, unless the droopy eyelid completely obscures the pupil.

Barring the presence of strabismus or ptosis, children may or may not show signs of amblyopia. Children may position their heads at an angle while trying to favor the eye with normal vision. They may have difficulty seeing or reaching for things when approached from the side of the amblyopic eye. Parents should see if one side of approach is preferred by the child or infant. If an infant's good eye is covered, the child may cry.

When to call the doctor

Parents should call the doctor if their child demonstrates any signs associated with amblyopia, including the appearance of crossed eyes, lazy eye, a drooping eyelid, difficulty seeing, or if the child seems to favor one side of approach over the other. However, since children do not always show symptoms of amblyopia, it is important to get their eyes examined at or before the age of three and no later than age five, while the disorder is more easily treated.