Amblyopia and Strabismus
At Alderwood Vision Therapy and Development, we are passionate about our brain-centered approach to binocular vision, and we especially love working with people of all ages with amblyopia and strabismus.
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Amblyopia, commonly known as “lazy eye,” occurs when one or both eyes do not develop sharp vision during childhood. It isn’t caused by a disease of the eye itself, but how the brain develops to use the visual input from an eye. The most common type of amblyopia is refractive anisometropic amblyopia—this happens when one eye has a much stronger prescription than the other (often due to farsightedness). As a result, the brain favors the clearer eye, and the weaker eye’s visual pathway doesn’t fully develop.
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Strabismus, often called a “crossed” or “wandering” eye, or a "squint", is a condition where the eyes don’t align and work together as a team. Instead of creating a single, combined 3D picture of the world, one eye may be aiming at a different point in space. A person with strabismus may experience double vision, but not always, as sometimes their brain has adapted and learned to "suppress" or ignore one eye's information. This misalignment can be constant or may only happen at certain times.
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Sometimes strabismus and amblyopia appear together, but they can also occur independently.​
Amblyopia can be improved at any age and without full opaque patching.
How are Amblyopia and Strabismus Treated?
At Alderwood Vision Therapy and Development, we take a comprehensive and sensory (eye-brain connection) approach to amblyopia and strabismus. Our treatment includes:
Binocular Lens Prescription
Our focus is to find a prescription (glasses or contacts) that looks to optimize binocular vision (eye teaming, depth) and not just the eye sight of each eye. If there is a large difference in power between the two eyes, often contact lenses or a "size lens" is recommended to reduce magnification of one eye's image, which helps the brain merge the two images and use the input from both eyes.
Vision Therapy
At our office, vision therapy is one-on-one, and individually planned week-by-week. For strabismus and amblyopia, it is used to both establish sensory fusion (seeing with both eyes together) as well as improve binocular vision and other visual skills that are often impacted by amblyopia (like oculomotor skills and visual perception). We use many tools in vision therapy, including virtual reality, eye tracking technology, and dichoptic presentations, but our primary goal is to ensure our patients can translate what their eyes and brain and learning to do into real life. This centers around our philosophy of the importance of vision therapy in free-space, using everyday tangible objects, instead of purely digital-based programming. Vision therapy can be successful alone or in conjunction to other treatments, and even before and/or after strabismus surgeries.
MFBF
In many cases, we use Monocular Fixation In A Binocular Field (MFBF), over the historical complete patching with an eye match. MFBF is a form of dichoptic viewing where both eyes still see a portion of the view, but only the amblyopic "lazy eye" sees the details. This allows more opportunity for the eyes to learn to work as a team while still training the amblyopic eye to see detail more clearly. One of the challenges of complete patching, and a likely reason why some people regress once patching is stopped, is that patching does not address the underlying binocular problem - it does not ensure that the eyes have learned to work as a team.
Strabismus Surgery Comanagement
Strabismus surgery is a procedure performed by an eye surgeon to adjust the muscles around the eye, helping to improve alignment. Surgery can be an important step for some patients. In our office, we comanage with surgeons by providing pre- and post-surgical vision therapy needed to strengthen the eye-brain connection and eye teaming skills to support lasting results.
Whether considering a first strabismus surgery, or you have already had three or more surgeries, we are here to support optimizing your visual system.
What can we do?
There are many effective treatments for both strabismus and amblyopia including: glasses, bifocals, prism, contact lenses, vision therapy, monocular fixation in a binocular field “MFBF”, partial patching, atropine drops, patching, and surgical intervention. Each individual’s unique diagnosis (evaluating onset, severity, frequency, and more), as well as their goals, will determine which treatment is most effective for a particular case and oftentimes a combination of treatments is recommended.
The first step to determine the best treatment options is to schedule an evaluation at our office.