This is the number one question I receive regarding strabismus. Most surgeons or ophthalmologists will recommend eye muscle surgery, but cannot guarantee their results.

Most optometrists will recommend Vision Therapy or a type of physical therapy to work on eye muscle coordination and control.

The truth is that there are several options depending on how much you, or your child’s eye is deviating, which direction, how often it drifts, and the age of onset. It’s also important to consider if there are any co-existing neurological factors such as a traumatic brain injury, or acquired brain injury (such as stroke or craniotomy) to determine the potential for improvement.

Surgery alone is never the best option. If you cut the eye muscle, but the brain doesn’t learn how to coordinate the eyes and use them together, the eyes will drift apart again, and another surgery will be necessary. The brain needs to be trained to function as a two eyed system and use the eyes as a team. This will minimize the likelihood of the eyes drifting apart after surgery, and will maximize cosmetic alignment as well as visual function (such as depth perception/stereopsis).

Doing nothing is also not a good option. A patient with strabismus has little to no depth perception which will affect their ability to judge depth and distances such as while driving a car or catching a ball. It will also diminish your reading skills because the brain must ignore or suppress the eye that is deviating to prevent from seeing double vision. This wastes energy and attention is drawn away from the task at hand. Also, when one visual pathway is not stimulated and developed, that side of the brain doesn’t develop, and amblyopia usually occurs where the eye is not correctable to 20/20 vision, even with glasses, contact lenses or LASIK.

Usually the best option is Vision Therapy if the amount of eye drift is small, or intermittent. A combination of surgery and Vision Therapy is best if the deviation is larger.

Dr. Elise Brisco

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