Wow Vision Therapy Blog

Imagine your child is diagnosed with amblyopia—commonly called “lazy eye.”

One eye sees 20/80 while the other sees 20/20.

The recommendation sounds simple:

Put a patch over the good eye for a few hours each day and force the weaker eye to see.

It’s inexpensive. It’s easy to prescribe. And patching has been used to treat amblyopia for generations.

There’s just one problem.

Amblyopia is not simply a problem of reduced eyesight in one eye. So why would we expect treatment aimed primarily at that one problem to rehabilitate everything amblyopia affects?

That is the question parents deserve to have answered.

Patching Can Improve Eyesight. That’s Not the Argument.

Let’s be clear: patching can improve visual acuity in an amblyopic eye. That’s a good thing.

But improving eyesight in one eye and rehabilitating the visual system are not necessarily the same thing.

Amblyopia develops because normal binocular vision fails to develop. The brain receives unequal or conflicting information from the two eyes and adapts by favoring one eye while suppressing or reducing its use of information from the other.

The result can involve much more than visual acuity. Amblyopia affects binocular vision, stereoscopic depth perception, eye movement control, visual processing, spatial judgment, eye-hand coordination and visually guided motor performance.

So, if amblyopia affects all of those abilities, why should treatment success be judged primarily by an eye chart?

The Eye Patch Has One Big Advantage: It’s Cheap

An eye patch costs very little. It doesn’t require specialized equipment, individualized rehabilitation or repeated one-on-one sessions with a trained vision therapist.

Its objective is comparatively simple:

Cover the better-seeing eye so the amblyopic eye has to work.

For some children, that can be an important component of treatment.

But parents should understand both what patching can accomplish—and what it may not.

There’s Another Cost to Patching That Isn’t on the Price Tag

The financial cost of an eye patch may be small.

The cost to a child’s daily life can be considerably greater.

Think about what we’re asking the child to do. We cover the eye that sees best and then ask that child to continue functioning normally—sometimes for hours.

Reading may become harder. Homework, playing, sports, watching television and simply navigating the environment may become more difficult.

Then there’s the emotional component.

Children may dislike how the patch looks or feel different from their peers. For parents, treatment can turn into a daily negotiation:

“Please put your patch on.”

“You have another hour to go.”

“Don’t take it off yet.”

Research has documented the compliance difficulties and social stigma associated with patching.

When a treatment makes everyday life more difficult, poor compliance should not surprise us.

Sometimes the treatment itself creates the barrier.

And There’s a Fundamental Contradiction

Amblyopia is fundamentally a disorder involving abnormal binocular visual development.

Yet traditional patching attempts to treat it by doing something interesting:

It eliminates binocular vision during treatment.

Improving one eye while the other is covered is fundamentally different from teaching the brain how to successfully use both eyes together.

Children don’t read, catch a baseball, ride a bicycle, walk downstairs, write, draw or navigate the world with one eye covered.

Life is binocular. Treatment should prepare the visual system for life.

What Happens When the Eye Chart Says “Success”?

Suppose a child’s amblyopic eye improves from 20/80 to 20/20.

That’s wonderful progress.

But before treatment ends, shouldn’t we ask:

Can the child use both eyes simultaneously without suppression?

Has binocular fusion and stereoscopic depth perception developed?

Can the eyes fixate, track and move accurately?

How are visual processing, visual-spatial abilities and eye-hand coordination?

If those abilities remain deficient, achieving 20/20 doesn’t necessarily mean the visual system has been fully rehabilitated.

Treatment Has to Work in the Real World

At Wow Vision Therapy, office-based vision therapy does not mean sending a child home wearing an eye patch for hours every day.

Therapy is active and individualized. We work on the visual abilities that need to develop and progressively change the activities as the patient’s abilities improve.

For appropriate patients, we can also use binocular virtual-reality activities at home. Instead of simply shutting off the better eye, both eyes participate while the visual information presented to each eye can be carefully controlled.

And because these activities are interactive and game-like, children often enjoy doing them.

That’s not insignificant.

The treatment that stays in the box doesn’t work.

Engagement isn’t merely a convenience. It’s an important part of successful rehabilitation.

Good Rehabilitation Doesn’t Just Improve the Easiest Thing to Measure

Imagine rehabilitating a child’s knee injury.

Suppose treatment restores the child’s ability to straighten the knee.

Excellent.

But can the child walk normally? Run? Balance? Climb stairs? Return to sports?

We wouldn’t judge successful rehabilitation by one measurement if the child still couldn’t function normally.

Vision shouldn’t be different.

20/20 measures clarity of eyesight. It does not measure the entirety of vision.

At Wow Vision Therapy, we certainly want the amblyopic eye to see as clearly as possible.

But we also want, when appropriate, to develop:

• balanced use of the two eyes,

• reduced suppression and improved binocular fusion,

• stereoscopic depth perception,

• fixation and eye movement control,

• visual processing and visual-spatial abilities,

• visual-motor integration and eye-hand coordination, and

• efficient vision for school, sports and everyday life.

That requires something different from simply covering an eye.

It requires active rehabilitation of the visual system.

Your Child Deserves More Than an Eye-Chart Goal

If your child has amblyopia and has been prescribed patching, I’m not suggesting that you simply throw the patch away.

Instead, ask a bigger question:

“How will we know when my child’s entire visual system—not merely the eyesight in one eye—has reached its best possible level of function?”

Because the goal of amblyopia treatment shouldn’t simply be to make the weaker eye read smaller letters.

The goal should be to give that child the best visual system we can possibly help them develop.

And when we understand amblyopia that way, the cheapest treatment isn’t necessarily the treatment that provides the greatest value.

If your child has amblyopia, contact Wow Vision Therapy to schedule a comprehensive developmental vision evaluation and find out whether there is more to your child’s vision—and their treatment—than what can be measured on an eye chart.

Dan L. Fortenbacher, O.D., FOVDR
Founder, Wow Vision Therapy