How to people with amblyopia see with the affected eye?

[hei213]

I wear glasses from a young age (6-7) and as far as I can remember I have a migraine-like issue with the central vision of my right eye. Note I can still read fine the chart (the letter I look at is blurred but others to its left are fine so I can guess it) and a comprehensive retina exam reported my eyes are in perfect condition.
I always wore the prescribed glasses and I have always had very similar dioptrees (0.25 apart I think). I have no strabismus nor did I ever have cataracts.

My question is, how do people with amblyopia see? Could this "migraine-like central vision" mean I have amblyopia?
My depth perception is fine and I still can read with my right eye only. The exam with a strobe light (or whatever that fast blinking apparat is called) came back fine, same value for both eyes.

[kingofvarden]

How do people with amblyopia see with the affected eye? I can only speak from personal experience, but for me, as a lifelong amblyope, it's exactly what it says on the tin - a lazy eye, with the brain largely suppressing the signal. It's like the kind of vision you get out of the corner of your eye, except the whole eye sees like that. Migraine-like symptoms are not a part of it.

[hei213]

Thanks, well the migraine-like vision might as well just a wrong phrase on my side, the letter I look at looks kind of like letter a bit away for the good eye. May I ask, do you have strabismus? And your amblyopia resulted from that?

[kingofvarden]

No strabismus. Mine was from removal of congenital cataracts that took place rather too late, and one eye proved more complicated than the other which resulted in an even longer period of no vision in that eye during early childhood when my brain was wiring itself for vision. Technically I suppose you could say both eyes are developmentally amblyopic to the extent that my brain just isn't wired for 20/20 vision in either eye, but the right eye had an especially prolonged period with no vision so is much lazier than the left.

[JohnHaganMD]

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[JohnHaganMD]

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[JohnHaganMD]

You will need to refine your question.  "Migraine like central vision" is not a term we ophthalmologist use.  Migraine is a syndrome in which headache is the most common symptoms but eye migraines have blanked/blurred/geometric patterns that blur out some of the vision but eventually go away. they are not always there. If you mean you always have a small blur spot in the exact center of your vision in your right eye that is not amblyopia.   It would indicate a small macular abnormality that might only show up on a macular OCT.   Do an Amsler Grid on yourself and then post what you see.

[Pearlvegas]

Absolutely Right Sir. "A migraine Like Central Vision" is not an appropriate term to describe our eye problem. Seriously, sir you always provided well-defined information for specific eye problems. I follow you last few months, thanks for sharing such informative tips.

[hei213]

Thank you for the reply. Both eyes are fine on the Amsler grid and I had dilated eye exams, OCT-s and visual field tests and ERGs, all was fine so it is not a retina/macula problem (this was my doctor's first suspect too ).
Compared to the left eye the right is a bit blurrier all in all, kind of like "I see a bit less" (with best corrected visual acuity) but I still can read (e.g. right now if I patch the left eye I can write this comment, though not convenient).
the letter I look at, and 2-3 other letter to its right are blurred, but to its left it is fine, apart from the overall slight blurriness.
AFAIK amblyopia can be more or less severe. What is the slightest kind of it you have seen in patients? Could they still read with the affected eye?

[JohnHaganMD]

What is your full glasses RX for each eye?

[hei213]

Right: -5.75D, -2.5 cyl 10 degrees axis.
Left: -5.5D, -1.5 cyl 170 degrees axis.

[hei213]

Note this is the current glasses. It was waaay weaker (AFAIK -1.00 -1.00 dioptrees) when I first had glasses at 6 years old.

[JohnHaganMD]

In the general population many people see better out of one eye than the other.  This is true of normal eyes without amblyopia.    It is a form of eye dominance.  Paired organs and not clones and identical. Thus people hear better  with one ear, stronger in one arm.  In your case you would expect the LE to see better because it has less astigmatism.  That could account for the minor difference in the eyes.  Also you should have a corneal topography if you have not had one done as you could have a form of keratoconus.

[hei213]

I will do that, but my fear is that my astigmatism and myopia was discovered too late (age 6) and my right eye didn't learn how to see. We had vision screenings during kindergarten but those were chart readings (I could already read at the time so I was shown letters or numbers) only (eyes separately), at that time no problem was found and my mother haven't noticed anything problematic either. For no apparent reason no ophthalmologyst has seen me until age 6.

The reason for the question was the concern if I had developed amblyopia due to astigmatism.

I will discuss this with an ophthalmologyst here in person too, but I would like your take on:

-     can astigmatism develop in childhood, before year 6 or is it always present at birth? For an astigmatism severe enough to cause amblyopia routine screenings would have shown issues.
-     Is depth perception ALWAYS an issue for amblyopes? Even for those with no strabismus but only myopic astigmatism and a mild amblyopia (20/30)? I have perfect coordination and I easily pass online depth perception tests, but will take one at the medical office too. Online contrast tests were the same for the two eyes, same good results.

[JohnHaganMD]

Astigmatism can develop anytime during life and change during life.   Perfect depth perception cannot occur in an eye with significant astigmatism but that does not mean the person will not have good depth perception and wonderful athletic/mechanical skills.  There are many olympic and professional athletes with severe amblyopia and some with only one eye.   amblyopia has to be treated by age 5-7 or it will not get better.  Getting children to screened for amblyopia by Eye MD or pediatrician has been a problem forever.

[hei213]

"Getting children to screened for amblyopia by Eye MD or pediatrician has been a problem forever" true that.
One thing though - how would you go on diagnosing a 23 year old if he has amblyopia? Just so I know what to expect or what to ask for during visit.

[JohnHaganMD]

On history.  If at some point in your life after age 6 the vision was equal and you did not see the tiny central blur are then you don't have amblyopia but an acquired problem maybe due to irregular astigmatism of the cornea.  If the RE has always been worse than your LE even when you first got glasses then you likely have mild amblyopia.   Read about 'microtropia" or "monofixator" syndrome described by Marshal Park MD. It is a common and often missed cause of small amounts of amblyopia.  

[hei213]

Thank you for the suggestions, I will do that. Thing is I cannot tell if I always had this problem. I know I had it for a long time, but I cannot tell if always. I'll be sure to ask for these during the visit as well.
Once again thank you for your help.

[JohnHaganMD]

Best of luck. If you find something definitive come back and post as a learning experience.