Sometimes I am asked by patients who have already obtained some degree of improvement by patching alone for lazy eye, why is it that I still recommend that they undergo vision therapy?
This is an excellent question, and understanding why I still recommend vision therapy will require that I share some information regarding how the brain processes information from the two eyes simultaneously.
When information from the eyes go to the brain, the information handled by the right brain is not the same as what the left brain handles. The right brain processes global awareness of where things are, while the left brain handles the analysis of details. Ideally, if someone has two eyes that work together well, the center of the two eyes will consistently aim at the same detail so that the images seen by each eye are properly aligned. This way, the brain is processing the central details AND the peripheral awareness information from BOTH EYES.
Individuals with lazy eye (amblyopia), typically have very poor stability and consistency of being able to get the eyes to align properly. Hence, rather than being able to consistently process both the central details AND peripheral awareness from both eyes, the brain decides to ignore the details from ONE eye because trying to fuse the images properly becomes too tiring. The tendency to ignore the details in one eye results in some degree of “central suppression” of the amblyopic eye. In short, the visual brain makes a subconscious decision to ignore the details in the amblyopic eye and only pay attention to global big picture awareness. Since the big picture awareness is still being fused to some degree by the two eyes, the amblyopic eye does not completely misalign to a notable degree like we see if those with an eye turn. Nevertheless, one might say that those with amblyopia or lazy eye actually have a “micro” binocular deviation.
So, given that this is the case, what happens when patching is done? By covering the eye that usually takes care of detail analysis, the eye that usually ignores details now has to take over that job. If done consistently, it can indeed improve in vision and maybe even reach 20/20! However, if we do ONLY patching, that means there has not been any attempt to get the two eyes to fuse together properly and consistently. As I said above, those with amblyopia actually have a “micro” binocular deviation. This needs to be treated through vision therapy if we want to have long term resolution of the lazy eye.
If you have any questions, or if you have a friend or family member with amblyopia, please feel free to contact us!
Frequently Asked Questions
1. What is the difference between patching and vision therapy for lazy eye?
Patching involves covering the stronger eye for a prescribed period to encourage the weaker eye to develop better vision. Vision therapy uses individualized activities to address visual skills such as eye coordination, focusing, tracking, and using both eyes together. Depending on the child’s condition, an eye care professional may recommend one approach or a combination of treatments.
2. Is vision therapy better than patching for amblyopia?
Neither treatment is automatically better for every child. Patching is an established treatment for amblyopia, while vision therapy may be considered to address specific visual skill or eye-teaming difficulties. The appropriate treatment depends on the child’s age, severity of amblyopia, and comprehensive eye examination findings.
3. Can vision therapy and patching be used together to treat lazy eye?
Yes. In selected cases, vision therapy may complement patching by addressing specific visual coordination and binocular vision skills. Treatment should be individualized and supervised by a qualified eye care professional, who can monitor progress and adjust the treatment plan as needed.