Lazy eye also called as Amblyopia is a disorder of sight in which one eye has poor vision that otherwise looks and appears normal or has a visual defect that is out of proportion to the structural problems of the eye. Hence the impact on vision is much more than predicted. In lazy eye, the brain suppresses the visual processing of one weak eye for a prolonged period of time to prevent double vision. This suppression starts early in childhood due to poor vision in one eye as a result of causes like high glass power, squint, and some opacity in the optical system like cataract or corneal scar etc. Due to lack of treatment at the right stage, it persists forever and can be corrected only till early teens. (Squint is best corrected before 5 years of age.) An estimated 1-5% of total population suffers from Amblyopia. Earlier detection of Amblyopia and treatment of the underlying cause of weak vision with glasses or surgery improves the suppressed vision with better long term outcomes.
One of the common causes for lazy eye is high glass power in one eye. Because of this differential power in the two eyes, our brain prefers the images received from the better eye and processing from the weak eye is suppressed. This suppressed transmission of visual images from the eye with higher power (weak eye) to the brain happens for a sustained period of time. This causes permanent hardwiring issues with brain and the sight on the affected side gets permanently reduced. This is something which can be restored only in childhood and cannot be corrected in adulthood. So no surgery can be done to make the eye see normal vision in adulthood if the amblyopia was not treated as a child.
Now with advances in the awareness and the treatment more and more children get diagnosed and treated at the right time. However some unfortunate ones who could not get treated at the right time continue to have the problem in adulthood as well. My mother is an example of the same problem. She had -14 D in one eye and -1 D in the other. It never got diagnosed when she was a kid and she resultantly is left with a lazy eye.
Recently a smart young man came for LASIK evaluation to the Center for LASIK surgery at Advanced Eye Hospital and Institute, Navi Mumbai, India. He wanted to join Navy and one of the pre-conditions was a perfect sight in both the eyes. He knew that he had a higher glass number in his left eye and even with glasses his vision was only 40% of normal vision. He came with the expectation that LASIK surgery with all its new advances like RELEX SMILE LASIK will not only remove his glass power but his vision will also come back to normal. I could understand his plight and where his beliefs stem from! We all expect that newer advances will someday take care of all our troubles. Hopefully some day we may have a good option for adult patients with lazy eye. However LASIK or SMILE Lasik can be great option to remove the glass power but we must understand that removing the glass power will not correct the vision to normal in the lazy eye as suppression is at the brain level even though it started at the eye level.
The other side of the problem with lazy eye is also due to different powers in both eyes. Due to high glass number in one eye, high power spectacle correction cannot be prescribed only in one eye as it can lead to imbalance between visions of two eyes. The eye with the higher power most of the time has to be given a lower power than actually required with the objective of balancing the power in both the eyes.
Now, what are the better solutions for adults with Amblyopia (Lazy eye):
Contact lenses: One of the solutions for such patients is to wear contact lenses. With contact lenses we can give full power prescription to the patient as chances of imbalance even with different powers in both eyes are less. Contact lenses can allow their eyes can see the best they can. In these people, one or two line vision improvement on the vision chart can make a lot of difference in day to day activities like driving etc.
Lasik surgery procedure: LASIK in cases of lazy eye due to different eye powers confers a lot of advantages. It allows even the lazy eye to get corrected of the number and hence see the best it can. This is especially beneficial for those who do not want to wear contact lenses. So a lot of times if these patients after their pre-LASIK evaluation are suitable for Lasik, we can consider LASIK or Femto LASIK or SMILE Lasik.
Visual limitations of Amblyopia are lifelong and hence it is very important to screen young children for lazy eye. We at Advanced Eye Hospital and Institute recommend school eye check-ups to be performed regularly to screen and diagnose these children at an early age. People older than 18 years having lazy eye due to high glass number in one eye can get themselves evaluated for LASIK. LASIK will not make the vision return to normal but will offer the best chance that the eye sees as well as it can!
About the author:
Dr Vandana Jain is a renowned Cornea and Lasik Surgeon heading the Centre for Lasik Surgery at Advanced Eye Hospital & Institute, Navi Mumbai, India. She is one of the best lasik surgeons in India and is an expert in Pre-Lasik tests, Corneal evaluation pre lasik and has done more than 5000 Lasik surgeries in her career spanning more than 12 years. At her centre, which is the best lasik surgery centre in western India, she offers counsel and advice for Custom lasik, femto lasik, Relex Smile lasik
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Dr Vandana Jain, Cornea and Lasik Surgeon, Mumbai, India 