LASIK and Amblyopia (Lazy Eye): what You Should Know

Amblyopia, more commonly known as lazy eye, is a condition where one of your eyes doesn't develop the way it should. Because LASIK is a popular vision correction surgery, many wonder if it can treat this issue.

Typically affecting children between 6-9 years old when the visual system is "learning to see," amblyopia creates an imbalance in vision between the two eyes, forcing the brain to prioritize what it sees, either from the stronger eye or the weaker one. Because the brain will focus on the stronger eye, the input from the weaker eye will diminish further, resulting in neurological pathways to develop incorrectly, according to Dr. Megan Lott, a developmental optometrist.

"This cannot be treated with LASIK or surgery of any kind," Dr. Lott says. "Since amblyopia occurs because of faulty visual neurological pathways, the best treatment is vision therapy. Vision therapy creates an environment where both eyes are treated as equals and the brain can then be retrained how to use vision properly."

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Identifying amblyopia and treating it before age 7 results in the best chances of correcting the condition. Treatments past that age, and specifically 10 years old, are limited.

LASIK (laser-assisted in situ keratomileusis) is a popular eye surgery used to treat nearsightedness, farsightedness and astigmatism. These refractive errors have been linked to amblyopia if the focus of one eye is severely weakened compared to the other.

While LASIK may correct any refractive errors it won't necessarily directly correct amblyopia. "LASIK eye surgery can only improve vision but it cannot alter the brain's incapacity to see," says Dr. Alan B. Schlussel, an optometrist. "Generally, patients with significant amblyopia vision loss are not good candidates for refractive surgery due to the potential risk of rare vision loss from the best corrected eye."

There may be an exception though.

Anisometropia is where two eyes have differing refractive power which results in an unequal focus between your eyes. This is typically due to having nearsightedness, farsightedness or astigmatism in one eye. Anisometropia can cause amblyopia because the brain picks the stronger eye to focus on, while resulting in a poor connection between the weaker eye and the brain.

LASIK may be a good option for someone struggling with anisometropia if they cannot wear contact lenses safely or correctly because the procedure will correct the refractive error, and thus, potentially the cause of amblyopia.

"The most important statement about LASIK in amblyopia is that, in general, refractive surgery is no better a treatment for amblyopia than glasses or contact lenses," says Dr. Benjamin H. Ticho, a board-certified ophthalmologist. "Refractive surgery is likely to achieve about the same vision as had been achieved by glasses or contacts. The one caveat to this statement is that LASIK may be useful as an amblyopia treatment early in life for children with very high refractive error only in one eye or in children who for developmental or psychological reasons will not wear their glasses at all."

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