Friday, February 11, 2011

Lazy Eye

I recently saw a baby who had crossed eyes and only used his right eye to see.  With some devoted patching by the mother, the baby began to see out of his left eye within one week.  This miracle still captures my imagination.  While my children are long grown now, here is another one of my old newspaper articles about a medical condition known as amblyopia.

My two year old is on a mission:  search and destroy Daddy’s glasses.  Whenever I lay them down, he stops whatever he is doing and runs over.  His eyes scan my face to make sure I don’t see his intentions.  Then he slowly stalks my glasses.  Usually, my military training takes over and a command and control voice saying, “NO!” is enough to deter him.  Sometimes, however, I do not see his approach.  As soon as my fragile wire and plastic spectacles are in his tiny hands, his feet start stomping in a victory dance and he scampers away to hide the loot.

One of the most fascinating therapies in pediatrics happens everyday, but never gets much attention.  Thousands of children across the country have a condition known as amblyopia, or the more common description, lazy eye.  Why do they call it lazy eye?  It’s a vision problem that happens in children a perfectly normal eye doesn’t see 20/20 even with glasses.  The eye is okay and yet the child cannot see because of brain development.

Although there are many different reasons for such a situation, one major cause of lazy eye is when both eyes are not straight.  Eye movement is a complex dance that requires more choreography than any Broadway musical.  Each eye is controlled by six different muscles and three separate nerves that come directly from the brain.  This control is further complicated because we have two eyes that must dance in step.  They have to move together to give us stereo vision.  Some hefty computing power in the brain makes all this happen.  If this system is just a little off, if the “wiring” is hooked up the wrong way, the child may develop crossed eyes.
Now the child's brain is faced with a dilemma.  It receives two different images.  Anyone who has ever experienced double vision will understand how confusing and disturbing this can be.  Little children don’t understand, but their brains work overtime to help them cope.  If the brain is confused by what it sees out of both eyes, then it may just ignore all the information that comes from one of the eyes.  If this happens for any length of time, the parts of the brain devoted for vision doesn’t develop properly.

Whatever the cause, children with amblyopia have brains that don't pay attention to the signals from an otherwise normal eye.  Despite all the fancy lasers and surgical technology that has developed over the years, the treatment is still simple.  If the brain is ignoring one eye, let’s retrain it.  A simple eye patch, like a pirate from the high seas, can cover the good eye.  Now the small child’s brain has to make do with the situation.  Over a few weeks to months, the brain literally changes.  Nerve cells make new connections.  Other cells start receiving signals that they didn’t get before.  The child begins to see again with his lazy eye.

This is not easy to do.  I always tell the parents that they are about to go into battle.  We take a child that sees out of one eye, and with a patch, suddenly we make that child go “blind” until their second eye starts to see.  Miraculously, these children do recover vision.  Now if only I can find my glasses, I would be able to see again.

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