Latest JAMA research shows impact of Amblyopia/Lazy Eye runs deeper into children’s lives

In the November 2018 issue of the Journal of the American Medical Association (JAMA) Ophthalmology, in a paper entitled: Self-perception of School-Aged Children With Amblyopia and Its Association With Reading Speed and Motor Skills, the researchers from the Foundation of the Southwest, Dallas, Texas Department of Ophthalmology, came to an interesting conclusion. In this cross-sectional study conducted at the Pediatric Vision Laboratory of the Retina Foundation of the Southwest, from January 2016- June 2017, involving 81 healthy children grades 3rd – 8th, 50 with Amblyopia and 31 without amblyopia, researchers learned that those children with Amblyopia have lower self-perception associated with slower reading speed affecting their scholastic competence and poorer motor skills which affects the child in their athletic competence, social competence and behavioral conduct.

This paper was particularly interesting to me because for nearly four decades I’ve had the privilege to provide care in this specialty of optometry known as developmental vision and rehabilitation, working to help children (and adults) to improve in their vision development. I have examined and treated hundreds of children with amblyopia (lazy eye) observing them initially struggle with a lower sense confidence in ball sports, general athletic ability, and for many, academically due to slower reading speed and fluency errors. While this observation of lower self perception, prior to treatment is a relatively common theme, after binocular vision therapy when the child gains depth perception, better eye-hand coordination, visual tracking and overall visual development, it has been particularly gratifying to see them blossom in reading abilities, sports performance and self confidence.  

Now, thanks to Dr. Eileen Birch and the team of investigators at the Pediatric Laboratory of the Retina Foundation of the Southwest,  we have this new research that validates these observations and more importantly shows, or strongly infers, that we must look at Amblyopia as more than just reduced visual acuity in the affected amblyopic eye. We must understand the overall impact that Amblyopia has on a child’s perception of themself and how treatment must target not only visual acuity but also binocular vision, depth perception, oculomotor and saccadic eye movement.

While every child with Amblyopia should have a comprehensive eye health and vision evaluation with proper lenses prescribed as needed, it’s important to emphasize, as written in previous VisionHelp Blog posts, patching or Atropine drops (occlusion therapy) alone will not address these issues identified by the researchers in this JAMA- Ophthalmology paper. Here are the conclusions by the researchers:


  • “The association between self-perception of scholastic competence and reading speed, along with our prior finding that decreased reading speed in amblyopia results primarily from an abnormally large number of forward saccades suggests that Amblyopia treatment may improve the self-perception of scholastic competence.”
  • “Data showing that motor skills improve following Amblyopia treatment suggest that treatment may improve the self-perception of athletic and possibly social competence.”

Here is just more evidence to show that the best approach for treating the many visual components of Amblyopia requires a comprehensive model of care, beginning with a comprehensive eye health and vision evaluation and treatment including office-based optometric vision therapy emphasizing binocular vision (stereopsis), oculomotor skills and visual motor skills with a personalized approach to transfer the visual skills being developed into the life of the patient.

For a more detailed look into Amblyopia, diagnosis, advanced treatment and research, go to the VisionHelp Amblyopia Project.

Dan L. Fortenbacher, O.D., FCOVD

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