What To Do About Strabismus / Eye Turn?


Vision Therapy vs. Eye Muscle Surgery

There is often disagreement between optometrists specializing in vision therapy and ophthalmologists who perform strabismus / eye muscle surgery on which option is best for patients with binocular vision conditions. Some believe surgery is the only way to achieve the desired results, while others say that surgery is unnecessary and rehabilitation/therapy can lead to improvement without the need for a surgery with inherent risks. 

Here at Nebraska Visual Integration Center, we believe that vision therapy should be attempted before considering surgery. It is highly possible that a visual issue can be corrected or improved upon with proper vision therapy, eliminating the need to go under anesthesia and permanently alter the muscles of one’s eye. 

Children who have gone through eye surgery may eventually have their eyeturn present again (often in a different direction), or their vision continues to be reduced, even if they look “normal”. This is because cutting the muscles in eye surgery does not TEACH the eyes and the BRAIN to work together, as is done in vision therapy.

Surgery may alter the eye muscles, forcing them to move or function in a certain way, but it is crucial that the patient learns how to control their eyes and rehabilitates the eye-brain connection through vision therapy for optimal vision. 

What Does the Research Say? 

A very important distinction between “successful” and “unsuccessful,” needs to be understood. The criteria for a “successful” surgery will almost always only consider only a “cosmetic” consideration and will not take into account any improvement in visual functioning like depth perception (3-D vision). Vision therapy is a slower process, but allows the brain the time that is necessary to understand how to use the eyes as a team and see in 3-D.  

Dr. Dominick M. Maino is a developmental optometrist who highly supports the use of vision therapy for strabismus and other visual issues. In his blog post “Evidence Based Medicine: Strabismus Surgery Outcomes” from COVD.org, Dr. Maino explored the research around the efficacy of surgery. He found that there is hardly any reliable or valid information on the efficacy of surgery because there is a lack of randomized controlled trials. 

The Vision Therapy Center summarized the statistics Dr. Maino wrote in his post:

  • only 45% of children had successful outcomes at an eight-year follow-up
  • 20% of the children had to undergo repeated surgeries for the strabismus 
  • 62% achieved a fair or poor outcome and that 60% required at least one re-operation

Past studies have shown that ~73% of patients with strabismus have improved to either develop full depth perception (3-D vision) or depth perception to a varying degree with <5% of the time with an eye turn/strabismus. 

Vision therapy is not only more effective, it is safer!  

Based on those statistics alone, surgery should not be considered first and should always be deemed a last resort. Even if one does end up needing or wanting surgery, undergoing a program of vision therapy beforehand can be helpful in reducing the severity of the issue and improving the outcomes of surgery. Also, it is important that a patient does vision therapy after an eye surgery. This is the same concept as a patient getting physical therapy after they break their arm, leg, etc. It is rehabilitative and necessary to gain back functionality.

Vision Therapy 1st; Surgery Considered Later (If needed)

Betsy Yaros is a blogger who wrote about her experience with eye surgery and vision therapy. She had significant eye turns, therefore she had a couple operations when she was young to fix them. The doctor tied her eye muscles in knots to prevent them from drifting in. As she grew up, her strabismus only worsened, and although doctors wanted to do another surgery, they couldn’t because she didn’t have enough muscle left in her eyes from her previous surgery. Then, in her twenties, Betsy discovered vision therapy. She shares her story of how vision therapy has helped her strabismus, allowed her to see 3-D depth, improved her confidence, and inspired her to go to optometry school. In her blog post, she specifies some pros and cons of both surgery and vision therapy. Read Betsy’s story here: http://www.betsyyaros.com/the-cost-of-eye-surgery-vs-vision-therapy/ 4

Surgery poses unnecessary risks, especially towards young children. Eye surgery is serious and invasive, and can be painful, traumatic, or emotional. When deciding whether or not to have surgery on yourself or your child in order to correct a visual issue, it is very important to get multiple opinions and be fully informed of your decision. If the topic of surgery comes up, consider vision therapy first!Resources

Evidence Based Medicine: Strabismus Surgery Outcomes

https://covdblog.wordpress.com/2014/04/02/evidence-based-medicine-strabismus-surgery-outcomes/ 

Vision Therapy Center

https://www.thevisiontherapycenter.com/discovering-vision-therapy/bid/101404/eye-doctors-should-work-together-to-decide-on-strabismus-surgery 

Betsy Yaros’ Story

http://www.betsyyaros.com/the-cost-of-eye-surgery-vs-vision-therapy/

Read More about surgery and vision therapy

Strabismus Treatment with Vision Therapy

https://www.visiondevelopmentinstitute.com/what-is-strabismus-vs-amblyopia-treatment/#:~:text=Strabismus%20Treatments%20%2D%20All%20Options&text=In%20other%20words%2C%20Strabismus%20Surgery,vision%20at%20the%20same%20time

The Number of Placebo Controlled, Double Blind, Prospective, and Randomized Strabismus Surgery Outcome Clinical Trials: None!

https://cdn.ymaws.com/www.covd.org/resource/resmgr/ovd42-3/ovd_42-3_journal_editorial_m.pdf