Detecting lazy eye in childhood key for optimal eye function

This story first appeared in Healthy You - January 2026, The Gazette’s quarterly health publication.

The most common vision problem in children is really a communication issue. Often known as “lazy eye,” amblyopia develops when the brain isn’t properly processing what at least one eye sees.

“Amblyopia is the leading cause of preventive vision loss in childhood,” said Dr. Christine Winter-Rundell, Cedar Rapids Eye Care staff optometrist specializing in pediatric care. “The eye itself is healthy, but the brain doesn’t recognize the image.”

When the condition isn’t detected and corrected, the brain relies on the stronger eye, and the weak eye deteriorates. Left untreated, the weaker eye can develop permanent damage through lack of use becoming a “lazy eye.”

The good news: amblyopia is relatively easy and inexpensive to treat. Detecting its symptoms early can be the biggest challenge with infants and toddlers who can’t tell their parents what they’re seeing.

“Our wish would always be that a kid be screened earlier,” said Winter-Rundell, ideally in a child’s first year. “That’ s a really critical period for being able to identify those little ones who are at risk.”

Absent other medical issues, infants should have seven pediatric checkups in their first year. But pediatricians also depend on parents’ observations.

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“We are always checking how their eyes line up and if the reflexes of the eyeballs are normal,” said Dr. Dinah Conti, UnityPoint Health pediatrician. “We would be able to see some signs, but every exam has its limitations, so we are relying heavily on what the parents are telling us.”

When the brain isn’t processing what one eye is seeing, an infant will try to adapt.

“It’s not like all of a sudden the eye goes blurry,” Winter-Rundell said. “Because this is their normal way of seeing, you’re not necessarily going to see these signs.”

Still, observant parents can be alert for clues and cues.

“Babies and young children show us they have vision issues by tilting their heads, having one eye that drifts outward or inward, or they may close one eye slightly,” said Conti.

To prevent permanent vision loss, the brain must be trained to use the weaker eye. The easiest method is wearing a patch over the stronger eye, usually for six months to a year.

“The treatment that has been around for centuries is patching,” said Winter-Rundell. “It is a very effective way to improve acuity.”

After her daughter was diagnosed in the 1990s, Cedar Rapids teacher Cathy Thompson designed a sleeve to fit over her eyeglasses. It proved more comfortable than an adhesive bandage, the only other option at the time. Thompson launched Patch Pals to provide comfortable patches with a bit of flare. The patches are sold worldwide, and the website patchpals.com provides advice and support for parents.

Atropine drops may also be applied to the stronger eye to weaken its focus so the brain prefers the vision from the amblyopic eye. In more extreme cases, surgery may align the eyes cosmetically without affecting their function.

“If it’s not paired with some sort of therapy, it may not result in 100 percent success,” Winter-Rundell said.

There’s tech for that now, too: Luminopia is an FDA-approved therapy using a virtual reality headset that strengthens a child’s weak eye as they watch their favorite shows. The system has produced significant improvements in children ages 4 to 7 who use the headset to view an hour a day over 12 weeks.

“Each eye gets the image to construct a 3-D picture,” Winter-Rundell said. “Kids are pretty motivated to get the brain to turn on the other eye so they can see the cartoon.”

Vision screenings once performed by Iowa’s area education agencies (AEAs) have been lost to state budget cuts.

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“That is gone in a lot of areas, so we may end up seeing more amblyopia through the years,” Conti said. “It is a daunting task to screen every child in Iowa, and the AEAs have done such a good job. There are a lot of underserved areas in Iowa.”

Options for children whose parents don’t have comprehensive insurance are the Lions Club International’s vision programs. (lionsclubs.org/en/give-our-focus-areas/vision/sightfirst)

“(It’s) a great program,” said Winter-Rundell. “They’re not going to pick up 100 percent of every problem, but they are good at picking up amblyopia risk factors.”

Another is InfantSEE (infantsee.org), a public health program sponsored by the American Optometric Association’s foundation. The program provides eye and vision assessment for infants six to 12 months old. Winter-Rundell is among the AOA members participating in the program.

Treatment therapies can be effective for amblyopia at later ages, too.

“Your brain can learn new things, even as an adult,” Winter-Rundell said.