Lazy eye treatment: your options explained

The short version

• Treatment usually starts by correcting the cause, with glasses, contact lenses or sometimes surgery [1][15].
• The next step is to make the weaker eye work harder, by patching the stronger eye or blurring it with atropine drops [1][16].
• Earlier is better. The National Eye Institute says "the sooner the better" [1]. The NHS says treatment should ideally start before age 7 [15], and the American Academy of Ophthalmology advises treating before age 7 or 8 [16].
• Treatment takes months, and vision can slip back when it stops [15][19].
• Dichoptic games and headsets are a newer option. The evidence is mixed, so talk to your eye doctor first. See our research review.

Step 1: find and fix the cause

Lazy eye often has an underlying cause. The NEI lists refractive errors, misaligned eyes (strabismus) and cataracts [1]. The AAO also lists a drooping eyelid (ptosis) that blocks vision [16].

Glasses and contact lenses

Glasses or contact lenses correct differences in focusing between the eyes. They are usually the first step [1], and they are often worn together with other treatment [15]. In one large trial of children aged 7 to 17, about one in four improved with glasses alone. Even so, most children who start with glasses alone need further treatment [18].

Surgery

Surgery treats a cause. It does not treat weak vision directly. The NHS says surgery may be used for cataracts or a drooping eyelid. It also says that surgery to straighten the eyes "does not improve your vision" [15]. The AAO says patching usually continues after surgery to fix the underlying problem [16].

Step 2: make the weaker eye work

Patching

A patch over the stronger eye makes the brain rely on the weaker one. The NHS describes a few hours a day for several months, usually together with glasses [15]. The AAO says treatment lasts several months and is sometimes part-time for years [16]. Our guide to eye patching has the details.

Atropine drops

Drops in the stronger eye blur its vision for a while, so the weaker eye does more of the work [15][16]. In a trial of 193 children aged 7 to 12, weekend atropine and patching for 2 hours a day gave similar gains at 17 weeks: 7.6 letters for atropine and 8.6 letters for patching [17].

Glasses with a blurring lens

The AAO also lists glasses with a blurring lens over the stronger eye as an option [16].

Step 3, sometimes: dichoptic and binocular therapy

Dichoptic therapy shows a different image to each eye at the same time. The aim is to get both eyes working together, instead of covering one. It is newer than patching, and the evidence is mixed.

One headset therapy has US FDA authorization for ages 4 to 7, as an add-on to glasses [14]. It beat glasses alone in a trial of 105 children [8]. But the largest trial of an iPad game did not show it was as good as patching [2]. Our explainer and research review go through the studies. We also have a page on vision therapy.

How long does treatment take?

Expect months, not weeks. The NHS mentions several months of patching [15]. The AAO says it takes several months for the weaker eye to get stronger [16]. Your eye doctor will check the vision in each eye at follow-up visits and adjust the plan.

Will the lazy eye come back?

It can. One review of records covered 449 children and 653 patching trials. In 27% of the trials, vision dropped back within a year of reducing or stopping patching [19].

An observational study of children patched for 6 to 8 hours a day found that tapering treatment, rather than stopping it suddenly, was linked to about four times lower odds of recurrence [20]. That study was not randomised, so it shows a link and not proof. Ask your eye doctor whether to taper and how often to review vision afterwards.

Is it too late?

Treatment works best in young children, but older children can still improve. In the trial of 7 to 17 year olds, 53% of the 7 to 12 year olds who had patching, close-up activities and atropine improved by two or more lines, compared with 25% who had glasses alone. Among 13 to 17 year olds, patching may help if the amblyopia had not been treated before. It seemed to help little if patching had already been tried [18].

The NEI notes that treatment is usually less effective in adults than in children [1]. Our page on lazy eye treatment for adults looks at the research.

Options at a glance

Questions to ask your eye doctor

• What is causing the lazy eye, and has that been corrected?
• Which treatment do you recommend first, and for how long?
• How will we measure progress, and how often will vision be checked?
• Should we taper treatment when vision improves?
• Would a dichoptic game help us, given our age and treatment history?
• What should make us call you before the next visit?

About ZyncView

ZyncView is a separate product from anything described on this page. It is a set of free browser games and a reading exercise for vision training and eye coordination, played with red/blue glasses. It is a wellness and entertainment product. It is not a medical device, it is not a treatment for lazy eye or any other condition, and it has not been tested in a published trial. If you are worried about your vision or your child's, see an eye care professional first. You can try the games or read how dichoptic games work.