Indmedica - India's Premier Medical Portal - Cyber Lectures


Active Vision Therapy II

Dr. Arun Verma

Page 2


Patching Only

When the treatment procedure involves patching only, the child’s strong eye is covered for eight to twelve hours a day over a long period of time, usually weeks or even months. By forcing the weak eye to work full time, its vision improves. However, there are serious drawbacks to this option. First, because the good eye is covered for most of the day, the child cannot see well and is often frustrated and uncooperative. It becomes difficult for the parents to keep the patch on the child all day long, week after week. Often the patch has to be taped over the child’s eye to prevent him from removing it. Over a period of time, the skin around the eye can become irritated and raw. Also, there is danger of loss of vision in the good eye when it is covered most of the time for weeks on end. In the face of these hardships, patching often fails because the child and parents give up.

Unfortunately, the gains from patching are not always permanent. Even if the family successfully makes it through the original patching ordeal, it is not uncommon for the child to have to continue with periodic patching in order to maintain the improvement in vision. This is because strabismus (squint), or the other underlying cause of the lazy eye, was not treated. Because a lazy eye is a brain-based problem, the brain must be taught to align and use the two eyes together. Without intervention to train the brain how to correctly use both eyes simultaneously, a child’s visual system will still suppress the weak eye. As a result, much of the lazy eye’s gains from patching will be lost over time. Once patching is stopped, the vision in the lazy eye degenerates if nothing has been done to teach the child’s brain to use both eyes together.

Patching With Surgery in Cases of Squint

In addition to a full time patching regimen, eye surgeons sometime recommend surgery to “correct” the strabismus, or crossed eye. Unfortunately, eye surgery does nothing to restore normal two-eyed vision, which is a learned process of the brain. Surgery simply makes the eyes appear straight by cutting muscles and repositioning the eyes in the head, a cosmetic “fix” but not a visual cure. Surgery cannot correct the improper habits the brain learned which caused the misalignment problem to begin with, nor can surgery train the brain how to use both eyes together. Most children who have undergone surgery for a crossed eye still suppress one eye full time. In order for the problem to be truly corrected, the brain must “unlearn” suppression and be trained to use both eyes together.

On an average, less than 20% of children who undergo eye surgery eventually achieve normal two-eyed vision. The few who do are nearly always very young children under the age of six years whose visual systems were still developing and fluid enough to fall into binocularity on their own.

Misconceptions about the “Critical Stage” for Treatment of Amblyopia

It is for this reason that some parents are told that a lazy eye can only be corrected when the child is very young, usually age six or under, the time when a child’s visual system is still naturally “moldable.” Some doctors feel that if treatment is not undertaken during this “critical stage” of development, the amblyopia becomes fixed and untreatable. Parents of older children with lazy eyes are often told that it is too late to treat the problem.

While these doctors are well intentioned, they are wrong. Eye surgeons who believe that a lazy eye cannot be treated after the age of six years simply lack the background and necessary training to correct a lazy eye in older children. Because they are not schooled in the functional remediation of binocular vision problems, they do not have the capability to treat older children. It is true that correcting amblyopia in a younger child makes the treatment easier, but older children and even adult patients can be cured of a lazy eye through active vision therapy. We have treated more than 5000 patients over the past 8 years and many of our patients are above the age of 20 years.


Active Vision therapy is much like physical exercises for the eyes. Active Vision therapy is prescribed by eye surgeons who specialize in children’s vision and are experts in the diagnosis and treatment of children’s vision disorders, including amblyopia and strabismus. Active Vision Therapy is highly successful in improving the function and performance of a lazy eye. Therapy corrects not only the poor vision in the lazy eye, but it also corrects the underlying problem of the brain’s inability to align and use both eyes together. During therapy, the patient’s brain is trained to stop suppressing the lazy eye, the visual pathways from brain to eyes are improved so the patient can keep both eyes aligned, and finally the brain is taught to fuse the images coming in from both eyes for normal binocular (“two-eyed”) vision. Our research and experience has showed that active vision therapy restored the visual system to normal in 92% of cases. Even in the remaining 8% of cases, those most severe instances of lazy eye complicated by additional circumstances, therapy could improve the child’s sight to more functional levels. And this can be done at any age, even into adulthood. An older child or a patient with difficult complications will need therapy for a longer period of time, but success at rehabilitating a lazy eye is possible for all children regardless of their age. Come and see the results at our center.

When amblyopia treatment is limited to only patching or surgery, no measures are taken to rehabilitate the dysfunctional vision system. Consequently, any treatment that does not address the root cause of the problem is entirely dependent upon the fixed time frame when vision normally develops. Active Vision Therapy, on the other hand, aggressively stimulates and guides visual development, actually reprogramming the brain to perform visual functions not previously developed on its own. When active vision therapy actively develops the patient’s visual acuity and improves binocular function, all children can experience excellent clinical results.

Like other interventions, active vision therapy usually involves patching the strong eye to force the weak eye to work, but for much shorter periods of time, sometimes not at all, if the child resists it. Rather than full time patching for up to twelve hours a day, a patient in active vision therapy will usually be asked to patch for two hours. Much less patching time is necessary when the child’s visual system is also being trained how to use the weak eye properly. By the end of therapy, the child’s patching time will be eliminated altogether. The gains achieved in active vision therapy are permanent. This is because once the child’s brain learns binocularity, or how to fuse the images from both the left and right eye together, the child’s visual system has been fully restored to normal. Fusion of the two eyes’ images is the glue, which permanently holds the vision system in place because it’s easier to see correctly than to have each eye see separately. Binocular fusion keeps the eyes from drifting out of alignment; and because there is no longer a need for the lazy eye to suppress, its improved acuity, or sharpness of vision, is not lost over time.

Some of the Conditions Which We Have Treated

1. Functional causes:

  • Strabismus (Squint or cross eye)
  • Uncorrected anisometropic myopia.(short sightedness)
  • Uncorrected anisometropic hypermetropia(long sightedness)
  • Uncorrected anisometropic astigmatism
  • Combined anisostrabismus

2. Refractive causes

  • Uncorrected isometropic myopia
  • Uncorrected isometropic hypermetropia
  • Uncorrected astigmatism

1 2 3 Previous page Next page Back