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Home > How We Help > Visual Perceptual Problems > Amblyopia & Suppression > Streff Syndrome

Streff Syndrome

What is a Syndrome?

A syndrome is the name given to a group of signs, symptoms & characteristics that often occur together.

The term is derived from Greek and translates as "together"  ~ on the same ~  "track".

The term Syndrome is used to quickly & clearly communicate the cluster of things that go together.

Once the definition of a particular Syndrome has been laid down, it allows a Diagnosis to be made, and a Diagnosis leads to Treatment.

Who is Dr John Streff?

In the 1930's Dr John Streff, an American optometrist, began research at the Gessell Institute of Child Development in New Haven, Connecticut. In 1962 he first coined the term 'Streff Syndrome' which is also called 'Juvenile Bilateral Functional Amblyopia' (JBRA), and some refer to it as 'The Non-Malingering Syndrome'. Streff's Syndrome is now recognized internationally.

Streff Syndrome

The signs, symptoms & characteristics are;

  • Healthy eyes, Healthy Visual Pathways to the brain and Healthy brain ( i.e. no disease)
  • Reduced Visual Acuity at both distance and near with both eyes, which is not improved by glasses
  • Reduced contrast sensitivity
  • An inability to "focus in" or "stick to" reading
  • Difficulty controlling their eye movments
  • If questioned carefully, it will be discovered that it is not for lack of trying that they struggle; the harder they try to be obedient to the requirement to do their near work, the worse the vision becomes.
  • An underlying stressing factor

This condition is frequently seen in children with above average intelligence who are having reading, writing, learning and/or behaviour problems.

It is twice as common in girls than boys, and generally appears between the ages of 8 and 12 years old.

It is common for the child to be accused of not telling the truth (malingering) because the Optometrist or Eye Surgeon does not understand the problem.

The explanation of Streff Syndrome

The key to understanding Streff Syndrome is understanding the child's stress.
It may be visual stress, emotional stress, the pressure of schooling, Physical or Psychological trauma.

This Visual Perception signs can develop quickly and make the eye coordination poorer, learning harder work and the child's behaviour is likely to be more erratic and subdued.


Due to the lack of general understanding of this condition by doctors and optometrists, teachers and parents, these chiildren are often mislabeled as 'lazy', 'disobedient' or 'naughty'. They can be accused of pretending that they have a vision loss for the purpose of trying to get glasses (malingering).
In my 30+ years of practice, I have only had a couple of children who just 'want glasses' to be cool. The fact is that children typically tell the truth, and glasses are not that cool!


Every day brings it stresses.
Learning to coping with stress is a key part of growing up.
            (Hence it is Juvenile's who experience Streff Syndrome)
We all have a natural mechanism to cope with stress.
It is called the Sympathetic Nervous System - often referred to as the 'Fight or Flight response' and it gives a surge of natural drug called adrenaline into our bloodstream.
Good though this surge is, it is a very fatiguing state to be in for more than half an hour.
As we fatigue, we have to shut down some functions and for stressed kids in a classroom or reading on the eyechart, it is their Visual Perception, a brain function, that they 'shut down'
             (Hence it is a Functional suppression/Amblyopia of Bilateral Vision)
It is the consequences of this response that form the cluster of findings that are Streff Syndrome.

When you think about it, it is a very sensible reaction to an overwhelming stress.
The key step is to provide the child with a way through the crisis.

The last thing they need is to be told off for not telling their truth!

How is Streff Syndrome treated ?

Streff Syndrome usually responds well and rapidly to treatment.

For your child to be listened to and understood, recognised as having a problem is a key part of the management. They need to know that this is a temporary state, it will come right once we ease the stress.

Low powered glasses have been proven to give rapid relief of the stress on the visual system. These spectacles reduce the effort your child has to exert to focus on close objects, giving their visual system time to recover and regroup. there is seldom reisistnace to wearing the glasses - the child wants the stress to go away and don't mind how we do it.

Retesting of the vision after 6-8 weeks of wearing glasses frequently shows improvement of the distance vision to normal (6/6 or 20/20 as its called in USA) after this short period.

The Binocular Co-ordination usually takes longer to recover and in some cases a course of Optometric Vision Therapy (eye exercises) is also required to re-learn their previous visual skills.

But often the glasses are the only treatment required. Your child can usually be weaned off the glasses after 12-18 months and the condition rarely recurs.

What you should do ?

If your child experiences blurred vision, sore eyes or headaches, and difficulties with reading then they should have an eye examination to determine the cause.

At VisionLink we specialise in understanding children with Streff Syndrome.

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