Joel Hunter, MD Refractive Surgeon, Hunter Vision Updated 10/23/20 3:24 PM
The best place to start with the question “Can LASIK fix lazy eye?” is to figure out what we’re really asking. A lazy eye is one of those diagnoses so firmly rooted into our common vernacular that the specifics of the condition get lost.
It’s similar to wondering if there’s a surgery that can fix a “bum knee.” It’s gonna take getting down to the nuts and bolts (or specific anatomy and pathology) to determine whether that can be an easy fix, or, sorry to say—impossible.
In this case, a lazy eye is usually thought of as an eye that looks in the wrong direction or can’t see well. But why does it look in the wrong direction, or for that matter, why can’t it see well?
The answer to both of these questions usually isn’t found in what’s happening in the eye, but instead lies further back in what’s misfiring in the brain.
Where good vision comes from
Quality of vision is determined by (1) how well the eye works and (2) how well the brain is processing information from the eye. Both components have to be there.
It’s impossible to say which one is more important. It’s like asking whether the right or left blade of a pair of scissors matters more. A person with perfectly functioning eyes and a brain with no visual cortex is exactly as blind as a person with a flawless brain and no eyes.
It’s an important point to make because eyes get all the credit. They’re right there on the front of your face. We see people every day with poor vision that is cured by glasses. Inevitably, we tend to assume that good eyes equal good vision. It’s reasonable because bad vision almost always means bad eyes. Almost.
A lazy eye, clinically known as amblyopia, would be an exception to this rule. Amblyopia is present from a very young age and persists into adulthood.
Why point this out? Well, it’s incredibly rare to develop vision problems because of a brain problem later in life. As a result, vision problems are further cemented into our consciousness as eye problems.
It’s very easy to get poked in the eye, but (thankfully) very difficult to get poked in the brain. When you take all of that into account, it makes sense for people to ask the question, “Can LASIK fix a lazy eye?”
It makes sense because we are asking about the only condition most people will ever encounter where bad vision is caused by the brain.
By this point, I feel like we’ve drawn a slightly clearer picture of the details behind the question. Maybe you read a lot of mystery novels or played Clue and have jumped ahead in solving this. But before you say, “No! LASIK can’t fix a lazy eye because the brain did it in the visual cortex with a developmental error!” you should know, there is one more chapter in the story.
No good detective story can finish without a twist. In this case, it’s that LASIK sometimes can help with a lazy eye. As for why and when, we must turn to a motive.
How is lazy eye different from crossed eyes?
I often hear people refer to amblyopia and strabismus as “lazy eye.” This is wrong. Let me expound on this.
When the brain “chooses” the eye with better vision, this causes the other eye to point in a different direction. It’s a visual problem known as strabismus, which is commonly observed among children although it may develop later in life. It’s what we commonly refer to as crossed eyes or deviated eyes, although take note that the eyes may cross in any direction: outward (exotropia), inward (esotropia), upward (hypertropia) or downward (hypotropia).
Crossed eyes is an eye issue concerning alignment whereas lazy eye is a visual acuity problem. Someone with crossed eyes has an apparent eye turn and therefore has difficulty combining each eye’s images into a single picture. It can be an intermittent or permanent occurrence.
With lazy eye, however, the brain suppresses one eye where it has a hard time getting a clear image that’s why visual acuity (or clarity) is affected. The brain and the better eye compensate for the inability of the other eye to see images clearly.
Three common reasons for lazy eye
We now know that amblyopia is a brain visual problem, not an eye visual problem, but we never uncovered why that problem shows up in some kids and not others. There are three reasons:
- One eye looks in a different direction. The brain hates double vision, so it “turns off” for that eye.
Strabismus can be a cause for lazy eye though in the form of strabismic amblyopia where one eye is constantly turning in a different direction.
- One eye has an obstacle blocking the vision. This is also known as deprivation amblyopia. The brain isn’t getting any information from the eye so it can’t develop vision for that eye. This can be caused by the growth of cataract that forms a cloudy area in the lens.
- One eye is just too blurry. The picture simply isn’t clear enough to develop vision for that eye.
This is considered as one of the most common causes of lazy eye. If one eye has severe nearsightedness or farsightedness while the other is in good condition, the brain will rely more on the latter as it tries to combine what it’s getting from the other. This is referred to as refractive amblyopia.
There’s also reverse amblyopia. It occurs when the unaffected eye develops amblyopia after treatment of the other eye. This usually occurs when the eye is penalized after wearing eye patches or using atropine eye drops (which I discuss in detail below). I want to point out, this is rare and is most definitely not a reason to ignore a pediatric ophthalmogist’s treatment recommendation.
Other reasons for lazy eye
Damage to the eye
Aside from cataracts that may lead to deprivation amblyopia, other factors that may damage the eyes include hypoplasia or underdeveloped optic nerves, glaucoma, eyelid tumor and corneal scar from intraocular tumor that causes bleeding and blurs the vision.
When the upper eyelids droop over the eye that it already covers the pupil, a patient may be suffering from ptosis. Children and adults will constantly raise their eyebrows or tip their head back so they can get a better vision. This may eventually lead to the development of lazy eye aside from stiff neck and headache.
Children usually develop ptosis at birth while aging and eye injuries remain the top causes for adults. Eye traumas, excessive eye rubbing, infection from debris that slip off rigid gas-permeable contact lenses, disruption of nerve pathways from the brain to the eye (also known as Horner’s syndrome) and even too much Botox also put anyone at risk.
Vitamin A deficiency
While food rich in carotenoids such as carrots, spinach, cantaloupes and sweet potatoes are familiar sources of vitamin A, it can also be sourced from whole milk, cheese and even chicken liver.
Vitamin A deficiency is commonly detected when one experiences night blindness. The eyes also become very dry and may lead to severe clouding on the surface. This cause is exceptionally rare in developed countries.
Genetics (family history)
Congenital factors that cause amblyopia are difficult to prevent. That is, if the condition runs in your family history, children may manifest its symptoms in their early years while there’s no stopping us from natural aging process.
Eye diseases and conditions that may be inherited include glaucoma, cataracts, eye malformations, retinal degeneration, and optic atrophy (damage to the optic nerves).
Direct injury to the eye resulting from punches, blows from playing contact sports such as boxing, rugby, martial arts and football, being hit by tools, equipment and chemicals at work and aerosol exposure may lead to bleeding, abrasions, trauma or intense burning.
Patients often complain about ongoing pain in their eyes, enlarged pupil size, swollen eyelids and ostensible bleeding.
In some cases, complications from eye surgery may cause further damage to the eye. This can be long-term and may complicate the distorted or blurry vision and optical aberrations that where experienced before the operation.
For instance, the eye lids are not guaranteed to be symmetrical after ptosis surgery. It may also lead to dry eyes since the eyelids do not close completely.
Lazy eye symptoms
It’s often difficult to detect lazy eye compared to the more obvious crossed eyes. However, several symptoms can help detect lazy eye. These include crossed eyes (or what they call weak eye teaming), poor depth perception, squinting eyes and frequent head tilting or turning.
Patients may also notice repeated eye shutting, severe eye strain, fatigue, eye strain, double vision, headaches and clumsiness while holding or throwing objects. You may also find patients bumping into things often.
If you’re driving, tracking moving objects may be difficult with your peripheral vision also being impaired. Worse, you may experience difficulty in your depth perception when looking at oncoming vehicles.
Remember, however, that amblyopia isn’t determined with self-diagnosis just because you’re experiencing any of these symptoms. Your eye doctor must always provide a formal diagnosis.
Lazy eye treatments
With early detection and treatment, lazy eye may still have a chance to be corrected.
Prescription eyeglasses can be used, especially by children who are too young for eye surgery. The eyeglasses need to be worn regularly for vision to improve. Eye turn may also be corrected depending on the patient’s condition.
An eye patch may also be effective when placed over the eye with good vision acuity. In this way, the lazy eye will be the only one to send images to the brain, which has no choice but to depend on the lazy eye. Eventually, it will learn how to adjust and (hopefully) the eye can recover its vision quality.
You’d just have to play Captain Hook for weeks or even months, so think about how children would react when forced to wear it. Thankfully, there are decorative eye patches that provide complete light blocking without you looking like to pillage a pirate ship in the next minute.
If you’re uncomfortable wearing an eye patch at work or your child is too self-conscious to put it on at school, your doctor may prescribe atropine eye drops. These drops are usually used before eye examinations to diagnose eye problems such as blurry vision.
To treat lazy eye, the drops are given once a day. What it does is to dilate the pupil so that the unaffected eye is temporarily blurred when focusing up close on objects. This compels the brain to use the eye with amblyopia.
Vision exercises can also be another option or a supplement to other treatments. These exercises, which can be done by children and adults at home to develop their eye teaming skills, include working on highly detailed coloring books, focusing or concentrating on a fixed object for a long time, answering word puzzles with small font size, completing line mazes on work books, tracing figures, reading magazines and newspapers with fine print, and other activities that help in improving the lazy eye’s track movement.
Pencil push-ups is a simple exercise where one has to focus on the eraser tip of the pencil at an arm’s length, while slowly bringing it towards the bridge of one’s nose until the vision turns blurry.
Playing video games can also help but make sure that it’s approved by your doctor.
You may also need to take vitamin A supplements along with vitamin C and vitamin E if you have a deficiency. In addition, food rich in lutein such as green leafy vegetables, and high in zeaxanthin such as spinach, broccoli and kale, may also be incorporated in your diet.
Just because you have amblyopia, doesn’t mean you can perform self-treatment, however. There’s no other better person to prescribe the appropriate treatment for your condition but your eye doctor.
And then, there’s LASIK surgery for lazy eye.
Your brain on LASIK
When someone is a candidate for LASIK in spite of some level of amblyopia, we find that something magical can happen. Despite a half-century of common wisdom saying (and I’m summarizing here) “the visual cortex you’ve got when you’re nine determines how good your vision can be,” we now know we can get better vision from our brains even through adulthood.
When a prescription gets fixed for an eye that hasn’t been doing much for all those years, it turns out the brain can go through a bit of an awakening too. When the vision is improved in the eye, it can start to improve vision at the brain level. It means that the ceiling for “this is the best I can see with glasses” can be raised higher, allowing even better vision after LASIK.
Can LASIK fix a lazy eye?
When one eye is just too blurry (where someone has a much higher prescription in one eye), LASIK can sometimes help.
There are some prerequisites to be met—the vision must be correctable to 20/40 and the vision must be poor because of a prescription that LASIK can fix—but in those cases, there is hope.
So, to answer to the question “Can LASIK fix a lazy eye?”, I can confidently give you a resounding “sometimes!” The chances of having the right level of amblyopia and the right reason for it make the odds of LASIK candidacy lower, but it is a wide and important gulf between low odds and no odds at all.
It may be that the story of your eyes has a plot twist of its own. And if it doesn’t, that’s okay too. It just means you’re more like the Rocky movies where everyone still likes you even though what happens is exactly what you expected.
How much is LASIK for lazy eye surgery?
Now that you’ve come to know about the possibility of fixing your lazy eye, it all boils down to the question: Can I afford a LASIK procedure for my lazy eye?
something that is worthwhile in the long-term? Given my lengthy discussion above, I have no doubt that your decision will be aligned to what I wrote in my earlier post.
Affordability is the next consideration. There’s no question that LASIK is a great personal investment but we understand that paying out-of-pocket is something impossible at this time.
The good news, however, is that eye surgery cost in Orlando, Florida is now more affordable with a payment plan tailored to your tight budget.
At Hunter Vision, we fully understand the value of taking care of your eyes with or without the expensive treatment procedures. You get expert care from one of Florida's best eye doctors BUT without asking you to dig a hole in your pocket though our payment plan.
Your eyes are too important to try to save a few dollars. Go somewhere that charges enough for you to be comfortable throughout the process.
We see far too many patients who tried to save a few dollars elsewhere end up here to see if we can fix what the other guys did. Most of our patients pay a bit over $130 per month at 0% interest for 24 months to change their whole world. I’d love to see you here, but I care way more that the place you choose is giving you all you deserve.
Our affordable payment plans for vision correction surgeries including LASIK can fit your tight budget. That's why we offer payment plans for as low as $130 per month - yes, that's not a typo - so you can start and end your day without your eyeglasses.
Author: Joel Hunter, MD is an Ophthalmologist, Refractive Surgeon, and the Founder of Hunter Vision, a LASIK Orlando Clinic in Florida. A recognized and respected specialist in vision correction who has performed a countless number of refractive surgeries, Joel gives lectures across the country and trains fellow doctors in the newest LASIK surgery techniques.
Last updated: August, 22nd, 2019