Seeing With Both Eyes Open

By: Debbe Geiger

Corey Nill was in first grade when he brought home a note from the school nurse saying he needed his eyes checked. “I thought, ‘what are they talking about? He sees fine,’” recalls Janet Fernandez, his mom. “He was reading at that point. He never indicated he had a problem. I almost wasn’t going to take him.”

Fortunately she did. Corey was diagnosed with amblyopia in his left eye. “With both eyes, Corey saw fine,” she explained. “But if you covered his good eye, he could hardly see.” The condition was so bad, the doctor told Fernandez “that Corey might not be able to get a driver’s license.” And because he was already seven, the doctor warned her that Corey’s brain had developed to the point where it might be impossible to reverse the damage.  Fortunately, Corey, now 15, is seeing fine, thanks to aggressive vision therapy.

Amblyopia, sometimes called lazy eye, is the most common cause of vision impairment in children, affecting about three percent in North America, according to the American Academy of Ophthalmology.  Left untreated, amblyopia can lead to poor vision and poor eyesight throughout life.

“Individuals with amblyopia are more likely to sustain injury to their good eye because they don’t see things coming at them,” says Stephen Kronwich, MD, a pediatric ophthalmologist at Winthrop University Medical Center in Mineola, NY.  There is also decreased coordination. “Your depth of perception is way down, and because of that, as they grow older, they have higher job related accidents and lower productivity on their jobs. And, if one eye sees poorly, the eye will start to drift out because it’s not being used.”

Amblyopia is not a seeing problem, but rather a brain problem.  During the early years of life, one of three things happens which prevents the connections between the eye and brain from forming properly. An ocular misalignment called strabismus may occur, meaning one eye turns in or out.  Amblyopia can also result when one eye needs glasses more than the other, but the need goes unrecognized because the good eye overcompensates. In rare instances, amblyopia is caused by a vision problem in one eye like cataracts which clouds the lens and diminishes the quality of the image the eye sees.

Discovered early on, most of the vision problems can be reversed. That’s because those pathways that connect the brain to the eye are still forming, and younger children are more compliant with treatment.  But by age 7, those pathways have become set in their ways. “It’s harder to teach an old brain new tricks,” says Kronwich. 

Now, however, new research says it can be done. According to a study sponsored by the National Eye Institute, children age seven to 17 can benefit from the same treatment used on younger children.  “The study showed it’s not a lost cause as some people used to think,” says Kronwich. “But it will take a lot of effort. What you really want to do is prevent it by seeing them early on.”

Treatment includes eye patches worn for part of the day, dilating eye drops, which blurs vision in the good eye, and prescription glasses, which corrects the vision in the amblyopic eye.  Patching the preferred eye retrains the brain to use the image coming through the non-preferred eye and improves the vision.  But keeping an eye patch on a child, especially as they get older, isn’t easy.  ”Corey didn’t like wearing the eye patch too much,” says Fernandez.   Her son, Dylan, who was diagnosed when he was three, “had no self consciousness about wearing the eye patch at all.”

But patching won’t do much if it’s not combined with visual therapy that promotes hand-eye coordination, and makes the weaker eye work harder.  Visual therapy might be as simple as filling in all the letter o’s in a newspaper, stringing cheerios on a shoe lace, or spearing individual raisins spread out on a table. Or it might be complex, using prisms, specialized equipment and other computerized techniques.

When Maryanne Vath of Selden, NY was diagnosed with amblyopia at age five, she remembers wearing a patch over her good eye and doing tracing books for at least six months. “If they didn’t catch it, I probably would have gone blind in that one eye,” she says.  Today, Vath is 40.  Because she knew amblyopia can run in families, she had her son, Peter, tested at the age of four. “Sure enough, he had amblyopia as well,” she said, although her eight-year-old daughter, Nicole, does not. “He had to wear the patch for three months. He played video games with the patch on.”  Video games, even hand held ones like Game Boys, are key components of therapy because they promote hand-eye coordination.

Once corrected, amblyopia isn’t cured. It requires life long follow up and may require additional retraining at any time. Fernandez says Corey now “has great eye sight.” But Dylan, now 11, has returned to therapy twice. “Just last year he had to go through therapy again because his eye sight in his right eye started slipping. It’s not uncommon,” she continued. “Even as adults they might have to go in for three months of therapy to strengthen the eye again. It’s something he’ll have to watch for the rest of his life.”

Debbie Geiger is a freelance writer who lives in Massapequa, NY