Eye Turns


Vision Therapy for Eye Turns (Strabismus)

The definition of strabismus is: any type of abnormal alignment of the eyes. There are many types of strabismus and therefore many factors to consider in order to determine how long it takes to treat it. Contrary to how it’s often presented, strabismus is NOT usually an eye muscle problem. It is usually a brain problem in which the brain needs to be taught how to use the eyes together and to blend the images of the two eyes together in order to attain depth perception. This is why patients who get eye muscle surgery frequently need to get multiple surgeries to keep the eyes cosmetically straight: the brain's ability to combine the two eyes' images was never improved. Here are a few items that we must look at and work on in vision therapy in order to achieve successful eye alignment.

Why Must We Try to Fix the Eye Turn?

An eye turn or strabismus doesn’t just affect the way we appear, it affects the way we perceive space. Try walking around for half a day with one eye covered up. You will find that it requires extra attention to perceive where things are around you and that it slows you down in general. An individual with strabismus needs to find ways to compensate for this somehow and there are usually certain skills which are deficient due to their inability to naturally see in 3D.

Are Glasses Needed?

There are certain types of strabismus in which glasses are necessary, in particular a condition called accommodative esotropia in which the patient is very far-­sighted and trying to see clearly through the far­-sightedness causes them to become cross-­eyed. In other cases, a bifocal will be beneficial in helping to make the patient’s eyes straighter. For some patients with exotropia (outward wandering eye) there is also a type that would also benefit from having reading glasses.

Is the Deviation the Same In All Directions?

It’s important to determine whether a strabismus is strictly caused by poor brain control or whether there is a nerve which is not working properly. In the latter scenario, the eye deviation will worsen in the direction where the weak eye muscle is supposed to move. Otherwise, the angle of deviation would be the same regardless of which direction the patient is looking. This tells us whether we can successfully treat the strabismus.

Binocular Fusion

An individual whose eyes are constantly misaligned is supposed to see double all the time. However, most patients with strabismus do NOT see double because their brains have made sensory adaptations in order to cope with their misaligned eyes. These sensory adaptations are the main reason why strabismus surgeries fail to keep the eyes aligned-­­the brain hasn’t learned to fuse the images of the two eyes properly. Vision therapy can overcome many of these sensory adaptations so that we can begin to work on training the eyes to stay together as a team.

Is There Also Amblyopia?

If there is also amblyopia or lazy eye in the deviating eye, we will also have to treat the amblyopia in addition to the strabismus. In this situation the lazy eye will also have a very poor sense of direction and will need plenty of training to establish accurate movement..

When Is It NOT Treatable?

If the strabismus is caused by a partially paralyzed eye muscle then we must look at why the muscle is so weak. In some cases the paralysis is temporary such as in a mild stroke, in other cases the result is permanent. There are a variety of different causes but if there’s no way to undo the weakness then of course vision therapy will not be able to treat it. Also, some patients have developed extremely embedded and efficient ways of adapting to their eye turn, which makes treatment very difficult. These are some of the cases which are probably better treated through surgery.

Contact us today if you have any questions about your child’s strabismus!

Successful Case Studies

  • Learning Difficulties

    Patient 1: LF, 39 year old male. Extremely slow reader ever since childhood, took 15 years to get his bachelor’s degree. He heard about vision therapy and wanted to see if it could improve his reading. Exam results: nearsighted in both eyes with small amounts of astigmatism mild convergence insufficiency (poor…

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  • Strabismus (Eye Turns)

    Patient 1: JS, 10 year old female. Her eyes drift outward alternately. Is also nearsighted and also wearing orthokeratology overnight lenses to see clearly. Also has a tendency to skip over small words when reading and ignores many details. When doing math problems she frequently misaligns numbers. Exam results: When…

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  • Myopia Control

    Patient 1: YS, 13 year old male. Mother was concerned about his eyesight deteriorating year after year. Just recently got new glasses which were much stronger than his old ones. Exam results: Needs ­-2.75 in both eyes to see 20/20 but other testing reveals that he should be capable of…

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  • Amblyopia

    Patient 1: CG, 6 year old male. Mom just found out that he had amblyopia in both eyes and wants to see if we could quickly treat it and get him to normal. Exam results: Highly farsighted in both eyes with astigmatism Both eyes see 20/100 only (5 times the…

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