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It's Never Too Late To Treat a Lazy Eye

Lazy eye, also known as amblyopia, is a big health concern, affecting between 1% and 4% of people in the U.S. It's the leading reason kids and young adults lose vision in one eye.

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Table of Contents

Why Amblyopia (Lazy Eye) Is Treatable at Any Age

Treatment Isn't Just for Kids

It's a common misconception that treatment for amblyopia, or lazy eye, is only effective until the age of 8. However, newer research shows that treatment options like vision therapy and advanced technologies are effective for people of all ages.

It's Never Too Late

Multiple studies have shown that amblyopia treatment is effective well beyond childhood. Research from the National Eye Institute and other reputable journals demonstrate improvement even in teenagers and older adults. These findings challenge the age-old belief that treatment should conclude by the age of 8.

The Age 8 Myth: Where Did It Come From?

Historical Background

The notion that treatment is only effective until age 8 likely originates from older studies focused on brain plasticity during early childhood. It was once believed that after a certain age, the brain couldn't adapt, making treatment ineffective.

What Modern Science Says

A large body of studies over the past 20 years has challenged this outdated concept of neuroplasticity. Our understanding of neuroplasticity has evolved, showing that the brain retains its ability to adapt even in adulthood, which opens doors for effective treatment at any age.

For example the authors of the study, Neural plasticity in adults with amblyopia, states “Our results suggest a significant degree of plasticity in the visual system of adults with amblyopia.”

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Amblyopia is a binocular vision problem and not a monocular one

One of the bigger shifts in understanding treatment for amblyopia is the concept that effective treatment of amblyopia requires not only the brain's reconnection with the amblyopic or weaker eye, but also the integration of that eye with the other eye. As the American Academy of Ophthalmology article titled “Amblyopia: Types, Diagnosis, Treatment, and New Perspectives” states: 

“Amblyopia typically affects visual acuity in one eye, and was always considered a monocular disease. For this reason, the main treatment has been occlusion of the fellow eye to improve the monocular function of the amblyopic eye. However, there are now a large number of studies showing that the deficit in amblyopia extends beyond monocular visual acuity impairment and into higher-order function such as binocular vision, fixation instability, and visuomotor activities due to abnormal interocular interactions.The common factors in those additional deficits in amblyopia are that they are not acuity-limited tasks; they require integration of information over relatively large regions of space and/or time, and they involve extracting a signal from noise.86 These deficits are not corrected by monocular treatment and remain even when visual acuity is recovered after patching.

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This quote underscores why traditional treatments such as patching is no longer considered the gold-standard treatment for amblyopia.

Key Limitations of Previous Studies

Limited Therapy Duration

Many earlier studies used a short therapy duration of 15 sessions or less, which may not be enough to evaluate long-term treatment effectiveness accurately.

Methods of Treatment

Earlier studies often didn't use the gold-standard of amblyopia treatment, known as Monocular Fixation in a Binocular Field (MFBF), focusing on patching alone. 

One prime example of this impacting the results of studies is the The Pediatric Eye Disease Investigator Group (PEDIG) Amblyopia Treatment Studies (ATS). This was the first major study that studied the efficacy of patching on children aged 3-7, 7-12, and 13-17.  The results showed that patching was effective for children up to 17 years of age, however the results were better for the 7-12 age group over the 13-17 age group. One could mistakenly assume that this was due to changes in the neuroplasticity of the brain, however the authors of the study did not attribute the difference in treatment response to a difference in visual plasticity. The authors hypothesize that the lesser treatment effect in children 13 to 17 years might be because it was more difficult for them to comply with 2 to 6 hours of daily patching with their overscheduled lives and/or they were not prescribed atropine. One of the many benefits of in-office vision therapy over patching is that it has a much higher level of compliance. 

In studies addressing the treatment of amblyopia in adults, orthoptics is frequently employed as a treatment method. However, it's important to note that while orthoptic therapy paved the way for modern vision therapy, the two are distinct approaches. Orthoptics primarily concentrates on exercises and activities aimed at strengthening eye muscles and enhancing eye alignment. In contrast, vision therapy has a broader objective: it seeks to optimize the entire visual system, encompassing both the eyes and the regions of the brain responsible for vision, visual perception, and related functions. Therefore any research that was done to examine the ability to treat amblyopia in adults that looked at orthoptic therapy, is extremely limited and has no bearing on the discussion of the efficacy of in office vision therapy.

Small Sample Sizes

Another common limitation is the use of small sample sizes, which can make it challenging to apply the findings to a larger population.

Tech-Based Studies and Age Groups

It's essential to note that some of the research on amblyopia treatment is funded by technology startups looking to validate their product as a treatment for adult amblyopia. While software is a wonderful tool, and can complement vision therapy treatment for amblyopia in an in-office setting, studies on software treatment do not translate to how effective treatment is with in-office vision therapy. For example, a groundbreaking study funded by the National Eye Institute (NEI) on convergence insufficiency treatment for children age 9-17, examined 4 treatment options including home based computer treatment. The conclusion of the study was that only in office vision therapy was effective at treating this condition, with software and pencil push ups having similar impact to placebo treatment. (https://www.nei.nih.gov/about/news-and-events/news/more-effective-treatment-identified-common-childhood-vision-disorder)

A look at studies on adult amblyopia treatment

A wide body of evidence shows that amblyopia can be treated in adults. While different studies show variable rates of efficacy, it is now widely accepted that the adult brain retains neuroplasticity. However even among the studies on adult treatment, there are major differences, mainly due to the method of treatment being done. Many of the studies are looking at patching (occlusion), pharmacological intervention (such as atropine drops that act in the same way as patching the stronger eye), and software based treatment.

Studies on Treatment for Adult Amblyopia

There is a lot of evidence that shows that it is never too late to treat lazy eye. While the studies below demonstrate that clearly, it is important to note that the studies employ a variety of protocols including patching, in-office therapy, and software based treatments. 

Binocular training reduces amblyopic visual acuity impairment. Age range: 5–73 years
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Perceptual learning improves stereoacuity in amblyopia. Age range: 11–27 years
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Effects of monocular perceptual learning on binocular visual processing in adolescent and adult amblyopia. Age range 12-25
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Pediatric Eye Disease Investigator Group. A randomized trial of a binocular iPad game versus part-time patching in children aged 13 to 16 years with amblyopia.  Mean age 14.3
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Amblyopia treatment of adults with dichoptic training, age range: 17–69 years
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Improving Adult Amblyopic Vision with Stereoscopic 3-Dimensional Video Games, age range: 19–79 years
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Anisometropic amblyopia: is the patient ever too old to treat?
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The iPod binocular home‐based treatment for amblyopia in adults, age range: 13–50 years
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Perceptual learning improves adult amblyopic vision through rule-based cognitive compensation., age range: 1–27 years
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Dichoptic training improves contrast sensitivity in adults with amblyopia. , age range: 17–31 years
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Mechanisms of recovery of visual function in adult amblyopia through a tailored action video game. , age range: 19–62 years
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A dichoptic custom-made action video game as a treatment for adult amblyopia. , age range: 19–66 years
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Differential effects of high-frequency transcranial random noise stimulation (hf-tRNS) on contrast sensitivity and visual acuity when combined with a short perceptual training in adults with amblyopia. Age range 27-58
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Recovering stereo vision by squashing virtual bugs in a virtual reality environment. , age range: 19–56 years
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Perceptual learning improves contrast sensitivity, visual acuity, and foveal crowding in amblyopia., age range: 17–53 years
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Amblyopia treatment of adults with dichoptic training using the virtual reality oculus rift head mounted display: , age range: 17–69 years
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Is there a critical period for amblyopia therapy? Results of a study on older anisometropic amblyopes., age range: 12–30 years
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An action video game for the treatment of amblyopia in children: A feasibility study. age range: 7–17 years
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Effectiveness of a binocular video game vs placebo video game for improving visual functions in older children, teenagers, and adults with amblyopia: A randomized clinical trial.  , age range: 7–55 years
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Dichoptic training in adults with amblyopia: Additional stereoacuity gains over monocular training. , age range: 21–29 years
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A random dot computer video game improves stereopsis.  Age range 7-14
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Use of a new composite index to demonstrate improved stereoacuity after training on stimuli with dichoptically asymmetric contrast. Age range 16-50
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Dichoptic de-masking learning in adults with amblyopia and its mechanisms.  Age range 19-28
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Most Effective Treatment for Lazy Eye in Adults

Most Effective Treatment for Lazy Eye in Adults

Vision Therapy: The Gold Standard

The most effective treatment for lazy eye (amblyopia) in adults is often vision therapy, specifically using the Monocular Fixation in a Binocular Field (MFBF) method. MFBF focuses on enhancing the weaker eye's ability to work in tandem with the stronger eye, aiming for improved binocular vision.

Backed by Research

Studies have shown that vision therapy using the MFBF method can significantly improve the visual acuity and binocular functions in adults with amblyopia. A study published in the Journal of Vision Rehabilitation noted marked improvements in adults undergoing MFBF-based vision therapy.

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Alternative Treatments

RevitalVision at Amplify EyeCare: A Game-Changer for Lazy Eye Treatment in Adults

We're excited to do a multi center trial of RevitalVision at Amplify EyeCare—a treatment program for adults with lazy eye that has been approved by the FDA. While we typically will recommend in-office vision therapy as the ideal treatment, this home based treatment can be a good option for those unable to make it to the office or have difficulty achieving results due to other considerations.  The whole program takes about three months and you can do it from home. It comes with 40 sessions that last around 30 minutes each. The sessions are designed just for you and an optometrist will be tracking your progress. Before you start, we'll do a functional eye exam at our eye clinic to see if RevitalVision is a good fit for you.

Patching and Atropine Drops

Though traditionally more common in children, patching the stronger eye or using atropine drops to blur it can sometimes be effective for adults as well. A study from the British Journal of Ophthalmology found moderate success with these methods, although they are often combined with other treatments, such as in office vision therapy, for more effective results that enable integrating the amblyopic eye into the binocular visual system.

Tech Innovations Revolutionizing Lazy Eye Diagnosis and Treatment

New gadgets and software are making it easier to both diagnose and treat lazy eye. For instance, CureSight, a digital treatment that uses eye-tracking and special glasses to help the weaker eye get stronger. Luminopia One and Vivid Vision take another approach, turning TV shows and movies into a kind of therapy by using a virtual reality headset. Lastly, for those 9 and older, there's RevitalVision. This FDA-approved program focuses on brain training to help improve how adults with lazy eye process what they see. All in all, technology is giving more treatment options for those for which in office therapy is not an option. However it is important to  note that any discussion of treatment should be done with a functional optometrist who can assess your needs and provide you with recommendations of what treatment will be most effective for you.

A look at studies on adult amblyopia treatment

Can Vision Therapy Help Adults with Severe Amblyopia?

The study looked at how active vision therapy can help adults who have a specific type of lazy eye called anisometropic amblyopia. Twenty adults, aged 17 to 35, took part in this study, which included five weekly sessions. These sessions used different eye exercises and also had a daily at-home program. To measure progress, the study used a vision test both before and after the therapy. The results were very promising but what was really interesting is that those who had poorer vision to start with saw even bigger improvements. 
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Common Questions

It is a misconception to think it is too late to treat lazy eye. Adolescents and adults have the advantage of generally being more compliant and determined to participate in the treatment plan as an older patient usually has a greater understanding of what is trying to be accomplished. Please allow yourself the opportunity to achieve optimal vision, no matter how old you are.
Yes, while it was once believed that lazy eye, or amblyopia, could only be treated during childhood, recent studies and clinical experiences have shown that adults, even those over 30, can benefit from treatment. It's essential to consult with an optometrist to discuss tailored treatment options, which may include vision therapy. Vision therapy consists of specialized exercises designed to improve the brain-eye connection and enhance visual function.
Eye patching, a traditional treatment for amblyopia, is most effective during the critical development years of childhood. However, its effectiveness can diminish as a person ages. While there's no definitive age cutoff, the general belief is that patching is most beneficial before the age of 10. That said, every individual is unique, and factors like the severity of amblyopia and patient compliance play significant roles. An optometrist can evaluate the potential effectiveness of patching for a particular individual and might suggest vision therapy or other interventions in conjunction with or as an alternative to patching, especially for older patients.
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Summary

No matter the age, if you have been diagnosed with amblyopia or you want to be checked if you have a lazy eye we strongly recommend scheduling an appointment in order to receive the eye care you deserve. To schedule a functional vision exam, you can reach out to your nearest Amplify EyeCare practice either via a call or in-person visit. Our team of eye care professionals is ready and equipped to provide you with the care you need.

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