Lazy Eye Doctor

Fotis Velissarakos is a sharp behavioral optometrist in Athens, Greece.  He isn’t an eye doctor who’s lazy, rather he’s an eye doctor who understands lazy eye.   That enabled him to share an item with the VT-DOC listserve and beg the question as to whether the introduction of “Captain Lazy Eye” represents the fast food version of vision therapy.  The term lazy eye is a terrible description of amblyopia, but let’s use it because it is the term being marketed in this direct-to-the-public attempt at amblyopia treatment.

The brainchild of a Taiwanese pediatric ophthalmologist, Captain Lazy Eye for the iPad is an attempt to package old school thinking into new school technology.  The theme is cute in terms of a patched pirate going on adventures, and certainly many young children respond to using iPad technology.  Yet there are several over-simplifications in approaching amblyopia therapy this way.  The first is perpetuating the myth that the “perfect” time for amblyopia therapy is between the ages of 3 and 8.  But why let research on neuroplasticity confuse you with the facts? Let’s look at the six categories of training in this app:

1. Rotating Grating – based on the theory of the CAM Vision Stimulator.  Dr. Ken Ciuffreda pointed out almost 30 years ago that this procedure was not better than any basic pencil-paper or eye-hand coordination game.  Incorporating the rotating grating pattern adds nothing of value.

2. Color Light Training – perhaps this is the the pediatric ophthalmologist’s attempt at syntonics.

3. Eyeball Muscle Exercise – a term sure to give Dr. Harry Wachs fits, and which appears to be little more than a basic tracking activity.

4. Hidden Object Recognition – a useful figure-ground activity.

5. Color Sensitivity Training – a combination of visual discrimination and perhaps a hint at contrast sensitivity.

6. Eye Hand Coordination –  essentially maze tracing.

Of course, VT-DOCs will recognize this iPad app is a fast-food version of Dr. Jeffrey Cooper’s Amblyopia iNet.  More than likely this iPad app is no more valuable to amblyopia therapy than any other video game the child would play while patched.  I certainly can’t find any research associated with the app that would allow the sale of it to be packaged as amblyopia therapy.  In contrast, Dr. Cooper’s computerized interactive therapy paradigm is widely used in optometric offices and as a complementary home therapy adjunct, and is well supported by research.

A quote from Arthur Schopenhauer that Dr. Cooper used in his lecture at the COVD meeting this year comes to mind:

All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.

– Leonard J. Press, O.D., FCOVD, FAAO

3 thoughts on “Lazy Eye Doctor

  1. We should have such a cartoon character who tell the latest truth about the treatment of amblyopia and visual conditions. We once had Dr. Tom.

    Michael Margaretten, O.D., F.A.A.O., F.C.O.V.D., F.A.C.O.P.

  2. Child’s cooperation is the most important for amblyopia correctional exercises.
    Captain Lazy Eye try to create a fun way to guide child accept patch eye.
    And makes training into fun and interesting games, increasing willingness to participate in correction.

    Thanks for your comments, we will keep to improve.

    • Thanks for the comment, Ideabus. Any activities that help actively engage the patient and stimulate visual pathways through the amblyopic eye are welcome. What I wish you would do, however, is acknowledge that the concept of using video games for this purpose is not new. I wrote about it in the Journal of Optometric Vision Development 30 years ago. (Press LJ. Electronic games and strabismus therapy. J Optom Vis Devel 1981;12(3):35-39.) Dr. Jeffrey Cooper pioneered this for amblyopia as an interactive format with graphs automatically monitoring progress. See: So while we welcome whatever pediatric ophthalmology has to contribute to therapy beyond patching and atropine penalization, I would encourage you to acknowledge the contributions of optometry. I say this not because we need the recognition, but because for many years pediatric ophthalmologists told patients that they needn’t do any form of active therapy together with patching. That day-to-day activities were sufficient. Many patients through the years were conflicted because their pediatricians nodded in agreement with the pediatric ophthalmologist that what we were saying was self-serving and we were trying to take advantage of patients by selling product or services. That was and is a travesty. It is time for your field to stand up, be accountable to the public, and acknowledge the optometric principles which you are now utilizing.

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