Advanced Treatment for Lazy Eye (Amblyopia) | Wow Vision Therapy

Hi! I’m Dr. Dan Fortenbacher, founder of
Wow Vision Therapy. Thank you for taking a moment to watch this video on
Amblyopia: Advanced Treatment for Lazy Eye. Amblyopia, otherwise known as lazy
eye, affects about 1 in 30 individuals, that’s about 3 percent of the population,
and as a result of this visual dysfunction the individual will have reduced
eyesight in one eye compared to the other, even with best
correction. That translates into deficiency in depth perception,
deficiencies in visually directed motor skills, in eye-hand coordination, visual
spatial judgments and a variety of other areas. Many times this has been coined as
a dominant eye and a lazy eye and it’s kind of like thinking of the dominant
eye as the bully, it doesn’t allow the lazy eye to play. We have two eyes, they have
to work together and that is known as a binocular vision. In order
to understand the cause of amblyopia you first of all need to understand that it
is due to a disruption in the normal development of an infant and toddler in
their binocular vision, typically due to one of two things. One is strabismus, which is a
form of binocular dysfunction involving a crossed eye or an eye that turns out. The
second is due to a refractive amblyopia, where there’s a significant difference
in the focus between the two eyes. The dominant eye has a normal focus and the
lazy eye has a significant refractive error that could be a large degree of
farsightedness, nearsightedness or astigmatism. It interferes with the site
development that occurs in the affected eye, it also results in the visual system
knowing how to use the two eyes effectively. As a result of the binocular dysfunction, a neural adaptation occurs that is known
as suppression. This is where the developing neural software in the infant
and young toddler, allows that child to experience single vision by shutting off
the affected eye. As a result, they do not experience the confusion of double
vision. And, therefore, effective treatment for this needs to be targeted on
remediating the dysfunction and binocular vision. One of the most common
problems associated with occlusion therapy, or patching, is compliance. A
child just resists wearing the eye patch because largely it creates such a
disruption to their overall ability to navigate around their environment. Think
of it, this child has poor eyesight and now we’re placing a cover on their good
eye and asking them to get around in their environment. I would challenge you
to try this yourself. Put a cover on one eye and try to walk around and see how
that feels. The other side of it is, wearing an eye patch draws attention to a
child and oftentimes in a negative way. Many times they can be bullied and that
can affect their self-esteem. As a result, a child will resist wearing an eye patch.
One of the advancements, in the standard model of amblyopia treatment, has been
the application of atropine. Atropine eyedrops is a way of penalizing the good
eye so that the amblyopic eye has the opportunity to see. And the way it works
is, the medicine temporarily paralyzes the focusing mechanism of the eye,
thereby acting like a patch. So while atropine has its advantages of force
compliance, it also has its own disadvantages that result from
heightened light sensitivity and disorientation. One of the common myths
that centers around amblyopia, is that age limits an individual from progressing
effectively treatment, and in many ways that is true when it comes to occlusion
or patching therapy; however, research has shown that advanced therapy including
binocular office-based vision therapy, age is no longer a barrier to success.
Vision therapy is an effective treatment modality based on a process that
involves learning. The visual system is a learned
system. We don’t come into this world knowing how to use our visual system, we
acquire this after we’re born. And so as this relates to children and adults with
amblyopia, is that they have not effectively learned how to use this part
of the visual brain. Vision therapy is a matter of organizing a series of
activities that allows them to learn these skills. The way it works is, we work
with our patients in the office one-on-one organizing activities that are
centered on a game, a visual game or challenge and in that game there’s three
things that are happening. One, there’s an awareness cue, that’s something to pay
attention to and it sets the stage for the next element of the game. That next
element is feedback, to be able to see if you’ve done the challenge correct or not.
Without that you will not have effective learning. So, awareness and feedback are
essential elements in the vision therapy experience. And the third one is, what we
call, loading. Loading is where we add something else into the drill. Something
else that involves multitasking. It could be balance, movement, listening
or thinking. The loading element is the accelerator to the learning experience.
Done at the right amount, it creates a greater challenge and the patient learns
the skill faster and transfers that into everyday life, faster. So, when we consider
the different treatment modalities for amblyopia, it’s not to say that occlusion
therapy is wrong, it’s just that binocular vision therapy is more right. The
overall treatment modality is more effective. Our patients amblyopia is
eventually cured! And with that comes an improvement in their visual acuity, their
depth perception and their overall judgment of visual space. That translates
to an increase in overall quality of life, self-confidence and happiness that
comes with better vision. For the latest information, including the most recent
research on the topic of amblyopia, I encourage you to go to the VisionHelp
blog ( To find a doctor who specializes in binocular vision therapy for amblyopia, I
encourage you to go to the COVD website ( and click on the doctor locator to find
a doctor nearest you, because… Life takes vision!

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