Treatment of Amblyopia

  • Nigel W. Daw


The treatment of amblyopia depends on the cause. In all cases, vision therapy is required—that is, exercises to teach the patient to move his/her eyes and to detect fine detail. Refractive correction is also usually needed, and these two factors together may be sufficient. In some cases, the eyes may need to be aligned, and in some cases a cataract or corneal opacity removed. Activity, movement, and eye-hand coordination are all important. Getting the eyes to work together should be done as soon as possible, to improve binocular function as well as acuity in the amblyopic eye. The treatment should be started as early as possible after the amblyopia has been detected. Clinicians also now realize that, if the patient has not been treated for one reason or another, adults with amblyopia can also be cured.


Perceptual Learning Binocular Vision Stereoscopic Vision Monocular Deprivation Visuomotor Coordination 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Baroncelli L, Bonaccorsi J, Milanese M, Bonifacino T, Giribaldi F, Manno I, Cenni MC, Berardi N, Bonanno G, Maffei L, Sale A (2012) Enriched experience and recovery from amblyopia in adult rats: impact of motor, social and sensory components. Neuropharmacology 62:2388–2397PubMedCrossRefGoogle Scholar
  2. Barrett BT, Bradley A, McGraw PV (2004) Understanding the neural basis of amblyopia. Neuroscientist 10:106–117PubMedCrossRefGoogle Scholar
  3. Barry SR (2009) Fixing my gaze. Basic Books, New York, NYGoogle Scholar
  4. Birch E (2013) Amblyopia and binocular vision. Progr Retin Res 33:67–84CrossRefGoogle Scholar
  5. Birch EE, Fawcett SL, Morale SE, Weakley DR Jr, Wheaton DH (2005) Risk factors for accommodative esotropia among hypermetropic children. Invest Ophthalmol Vis Sci 46:526–529PubMedCrossRefGoogle Scholar
  6. Birch EE, Stager DR Sr (2006) Long-term motor and sensory outcomes after early surgery for infantile esotropia. J AAPOS 10:409–413PubMedCrossRefGoogle Scholar
  7. Brock FW (1955) The string as an aid to visual training. Visual Training at Work, vol 4. Optometric Extension Program Foundation, Santa Ana, CA, pp 29–33Google Scholar
  8. Buffon M (1743) Dissertation sur la cause du strabisme ou les yeux louches. Historie Academie Rendue Science: 231–248Google Scholar
  9. Chung ST, Li RW, Levi DM (2012) Learning to identify near-acuity letters, either with or without flankers, results in improved letter size and spacing limits in adults with amblyopia. PLoS ONE 7:e35829PubMedCrossRefGoogle Scholar
  10. Chung STL, Li RW, Levi DM (2006) Identification of contrast-defined letters benefits from perceptual learning in adults with amblyopia. Vision Res 46:3853–3861PubMedCrossRefGoogle Scholar
  11. Ciuffreda KJ, Levi DM, Selenow A (1991) Amblyopia: basic and clinical aspects. Butterworth-Heinemann, Stoneham, MAGoogle Scholar
  12. Convergence Insufficiency Treatment Trial Study Group (2008) Randomized trial of treatments for symptomatic convergence insufficiency in children. Arch Ophthalmol 126:1336–1349CrossRefGoogle Scholar
  13. Daw NW (1962) Why after-images are not seen in normal circumstances. Nature 196:1143–1145PubMedCrossRefGoogle Scholar
  14. Ding J, Levi DM (2011) Recovery of stereopsis through perceptual learning in human adults with abnormal binocular vision. Proc Natl Acad Sci U S A 108:E733–E741PubMedCrossRefGoogle Scholar
  15. Dreifus C (2012) Ready, Aim, Fire. New York Times, August 27Google Scholar
  16. Drews-Botsch CD, Celano M, Kruger S, Hartmann EE (2012) Adherence to occlusion therapy in the first six months of follow-up and visual acuity among participants in the Infant Aphakia Treatment Study (IATS). Invest Ophthalmol Vis Sci 53:3368–3375PubMedCrossRefGoogle Scholar
  17. Etting GL (1978) Strabismus therapy in private practice: cure rates after three months of therapy. J Am Optom Assoc 49:1367–1373PubMedGoogle Scholar
  18. Fine I, Jacobs RA (2002) Comparing perceptual learning tasks: a review. J Vis 2(2):190–203PubMedCrossRefGoogle Scholar
  19. Fine I, Wade AR, Brewer AA, May MG, Goodman DF, Boynton GM, Wandell BA, MacLeod DA (2003) Long-term deprivation affects visual perception and cortex. Nat Neurosci 6:915–916PubMedCrossRefGoogle Scholar
  20. Frantz KA (1995) Rationale for refractive correction, occlusion and active therapy for amblyopia treatment. J Behav Optom 6:14–19Google Scholar
  21. Greenwald I (1995) Brock: a binocular approach to amblyopia therapy. J Optom Vis Dev 26:62–67Google Scholar
  22. Gregory RL, Walace J (1974) Recovery from early blindness: a case study. In: Gregory RL (ed) Concepts and mechanisms of perception. Duckworth, London, pp 65–129Google Scholar
  23. Griffin JR, Grisham JD (1995) Binocular anomalies: diagnosis and vision therapy. Butterworth-Heinemann, Newton MAGoogle Scholar
  24. He HY, Ray B, Dennis K, Quinlan EM (2007) Experience-dependent recovery of vision following chronic deprivation amblyopia. Nat Neurosci 10:1134–1136PubMedCrossRefGoogle Scholar
  25. Held R (1965) Plasticity in sensory-motor systems. Sci Am 213(5):84–94PubMedCrossRefGoogle Scholar
  26. Hess RF, Mansouri B, Thompson B (2010) A binocular approach to treating amblyopia: antisuppression therapy. Optom Vis Sci 87:697–704PubMedCrossRefGoogle Scholar
  27. Hussain Z, Webb BS, Astle AT, McGraw PV (2012) Perceptual learning reduces crowding in amblyopia and in the normal periphery. J Neurosci 32:474–480PubMedCrossRefGoogle Scholar
  28. Jampolsky A (1955) Characteristics of suppression in strabismus. Arch Ophthalmol 54:683–696CrossRefGoogle Scholar
  29. Jeon ST, Maurer D, Lewis TL (2012) The effect of video game training on the vision of adults with bilateral deprivation amblyopia. Seeing Perceiving 25:493–520PubMedCrossRefGoogle Scholar
  30. Kurson R (2007) Crashing Through. Random House, New York, NYGoogle Scholar
  31. Levi DM, Klein S (1982) Hyperacuity and amblyopia. Nature 298:268–270PubMedCrossRefGoogle Scholar
  32. Levi DM, Li RW (2009) Improving the performance of the amblyopic visual system. Phil Trans Roy Soc Lond 364:399–407CrossRefGoogle Scholar
  33. Levi DM, Polat U (1996) Neural plasticity in adults with amblyopia. Proc Natl Acad Sci U S A 93:6830–6834PubMedCrossRefGoogle Scholar
  34. Li RW, Ngo C, Nguyen J, Levi DM (2011) Video-game play induces plasticity in the visual system of adults with amblyopia. PLoS Biol 9:e1001135PubMedCrossRefGoogle Scholar
  35. Lloyd IC, Dowler JG, Kriss A, Speedwell L, Thompson DA, Russell-Eggitt I, Taylor D (1995) Modulation of amblyopia therapy following early surgery for unilateral congenital cataracts. Br J Ophthalmol 79:802–806PubMedCrossRefGoogle Scholar
  36. Ludlam WM (1961) Orthoptic treatment of strabismus. A study of one hundred forty nine non-operated, unselected, concomitant strabismus patients completing orthoptic training at the Optometric Center of New York. Am J Optom 38:369–388CrossRefGoogle Scholar
  37. Mansouri B, Schmidt B, Sing P, Pearson P, Globa A (2012) A new binocular treatment of lazy eye (amblyopia). Paper presented at the 2012 Neuroscience Meeting Planner, New Orleans, 163.12Google Scholar
  38. Maya Vetencourt JF, Sale A, Viegi A, Baroncelli L, De Pasquale R, O’Leary OF, Castren E, Maffei L (2008) The antidepressant fluoxetine restores plasticity in the adult visual cortex. Science 320:385–388PubMedCrossRefGoogle Scholar
  39. McGovern DP, Webb BS, Peirce JW (2012) Transfer of perceptual learning between different visual tasks. J Vis 12(11):4PubMedCrossRefGoogle Scholar
  40. Mitchell DE, Duffy KR, Holman K, MacNeill K (2012) The rapid recovery of visual acuity promoted by short periods of darkness in amblyopic kittens can be accompanied by the passive acquisition of stereopsis. Paper presented at the 2012 Neuroscience Meeting Planner, New Orleans, 837.04Google Scholar
  41. Mitchell DE, Sengpiel F, Hamilton DC, Schwarzkopf DS, Kennie J (2011) Protection against deprivation amblyopia depends on relative not absolute daily binocular exposure. J Vis 11(7):13PubMedCrossRefGoogle Scholar
  42. Moseley MJ, Fielder AR, Stewart CE (2009) The optical treatment of amblyopia. Optom Vis Sci 86:629–633PubMedCrossRefGoogle Scholar
  43. Narasimhan S, Harrison ER, Giaschi DE (2012) Quantitative measurement of interocular suppression in children with amblyopia. Vision Res 66:1–10PubMedCrossRefGoogle Scholar
  44. Pediatric Eye Disease Investigator Group (2005) Randomized trial of treatment of amblyopia in children aged 7 to 17 years. Arch Ophthalmol 123:437–447CrossRefGoogle Scholar
  45. Pediatric Eye Disease Investigator Group (2002) A randomized trial of atropine vs patching for treatment of moderate amblyopia in children. Arch Ophthalmol 120:268–278CrossRefGoogle Scholar
  46. Pediatric Eye Disease Investigator Group (2003a) A randomized trial of patching regimens for treatment of moderate amblyopia in children. Arch Ophthalmol 121:603–611CrossRefGoogle Scholar
  47. Pediatric Eye Disease Investigator Group (2003b) A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children. Ophthalmology 110:2075–2087CrossRefGoogle Scholar
  48. Perez GM, Archer SM, Artal P (2010) Optical characterization of Bangerter foils. Invest Ophthalmol Vis Sci 51:609–613PubMedCrossRefGoogle Scholar
  49. Press LJ (2008) Applied concepts in vision therapy. Optometric Extension Program Foundation, Santa Ana, CAGoogle Scholar
  50. Rouse MW (2004) Optometric clinical practice guideline: care of the patient with amblyopia. American Optometric Association, St Louis. MOGoogle Scholar
  51. Rowe FJ (2012) Clinical orthoptics. Wiley-Blackwell, ChichesterCrossRefGoogle Scholar
  52. Sacks O (1993) To see and not to see. New Yorker (May 10):59–73Google Scholar
  53. Sherman A (1995) Treatment of amblyopia without full refractive correction or occlusion. J Behav Optom 6:15–17Google Scholar
  54. Suttle CM, Melmoth DR, Finlay AL, Sloper JJ, Grant S (2011) Eye-hand coordination skills in children with and without amblyopia. Invest Ophthalmol Vis Sci 52:1851–1864PubMedCrossRefGoogle Scholar
  55. Tytla ME, Lewis TL, Maurer D, Brent HP (1993) Stereopsis after congenital cataract. Invest Ophthalmol Vis Sci 34:1767–1773PubMedGoogle Scholar
  56. von Senden M (1960) Space and sight. The Free Press, Glencoe, ILGoogle Scholar
  57. Wensveen JM, Smith EL 3rd, Hung LF, Harwerth RS (2011) Brief daily periods of unrestricted vision preserve stereopsis in strabismus. Invest Ophthalmol Vis Sci 52:4872–4879PubMedCrossRefGoogle Scholar
  58. Zhou Y, Huang C, Xu P, Tao L, Qiu Z, Li X, Lu ZL (2006) Perceptual learning improves contrast sensitivity and visual acuity in adults with anisometropic amblyopia. Vision Res 46:739–750PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Nigel W. Daw
    • 1
  1. 1.BranfordUSA

Personalised recommendations