115 Amblyopia and Strabismus

Strabismus is a disorder in which both eyes do not line up in the same direction. Therefore, they do not look at the same object at the same time. The most common form of strabismus is known as “crossed eyes.” The oculomotor muscles around each eye allow for both eyes to focus on the same object. When someone has strabismus, these muscles do not work together which causes the eyes to look in different directions. When this occurs, two different images are sent to the brain—one from each eye. This confuses the brain. In children, the brain may learn to ignore or suppress the image from the weaker eye. If the strabismus is not treated by training or surgery, the eye that the brain ignores will never see well and the brain will rely solely on the image from the stronger eye. This loss of vision in one eye is called amblyopia. In most children with strabismus, the cause is unknown and the problem is present at or shortly after birth.

Children and teenagers with strabismus experience decreased quality of life for numerous reasons. Oftentimes preconceptions, negative attitudes, and misconceptions from others contribute to the decreased quality of life experienced by children and teenagers with strabismus. In addition, children and teenagers with strabismus are more likely to worry about their eyes, have negative attitudes and misconceptions about themselves, and endure increased psychological distress.

Amblyopia, also called lazy eye, is a type of poor vision that happens in just one eye. It can result from strabismus or anisometropia. Amblyopia develops when there’s a breakdown in how the brain and the eye work together, and the brain can’t recognize the sight from one eye. Normally, the brain uses nerve signals from both eyes to see. But if an eye condition makes vision in one eye worse, the brain may try to work around it. It starts to “turn off” signals from the weaker eye and rely solely on signals from the stronger eye. This creates monocular visions instead of binocular. Amblyopia starts in childhood, and it’s the most common cause of vision loss in kids. Feelings of low self-esteem and negative self-image were reported as a result of amblyopia and/or its treatment. Other psychosocial implications included feelings of depression, frustration, and embarrassment. Bullying and interactions with peers were reported to occur as a result of amblyopia and/or its treatment. Noticeable differences in the change in appearance (by nature of wearing glasses and/or patch) meant that treatment was obvious to others. However, early treatment works well and usually prevents long-term vision problems. If caught and treated early, stereo vision can develop normally (Fig.10.8.1).