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Strabismus & Amblyopia
 

“Strabismus surgery can be a scary option for an eye drift. Also, the idea of patching, which creates a monocular world, may not provide the best visual system. Excel offers a non-surgical therapeutic approach to improve eye drift and poor teaming skills. In addition, we offer an option beyond patching to improve visual acuity and provide better functional skills for the visual system.”  

HOT OFF THE PRESS:

The presentation of an eye drift and/or decreased visual acuity in the eyes can cause a multitude of problems for those who suffer from these visual deficits. Strabismus is an eye drift that can be in, out, up, down, or up/down, etc. Eye drifts can cause many symptoms such as poor tracking skills (e.g., words moving on the page while reading), poor eye-hand coordination (e.g., hitting a baseball), balance issues, tired while reading, double vision, confidence issues, and more. When an eye drift presents it is important to first discover what is causing the eye drift. It can be as a result of many causes, including but not limited to, a high near- or far-sighted prescription in both eyes, high astigmatism in one or both eyes, an imbalance in the prescription between the two eyes, neurological disorder, or more. 

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Many factors are important to address with an eye drift such as the onset, frequency, symptoms, which eye(s) and the severity in which it affects eye teaming. Given the many potential issues related to strabismus it is important to have an examination by a doctor who specializes in vision development, eye teaming (binocular vision), and advanced knowledge on treatment options for patients. The doctors at Excel are trained in vision therapy and utilize this non-surgical approach stand alone or in co-management in select cases that pursue the surgical option. Therapy helps to improve and provide the best binocular or eye teaming skills to each patient. Strabismus surgery works on providing alignment but does not improve the brain’s ability to use both eyes together in many cases. In certain cases, once the eyes are aligned the brain may be able to fuse or align the two eyes at the sensory level. However, many patients require multiple surgeries or do not achieve eye teaming or depth perception following surgery. For that reason, therapy is beneficial to help teach the brain how to utilize the two eyes together! 

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In amblyopia, the vision is decreased in both eyes and in one eye versus the other. Normal visual acuity is the ability to identify the smallest object possible (minimal angle of resolution) at 20 feet (or equivalent). This is the famous 20/20 eye test. However, if the eye(s) is not able to achieve 20/20, then one may be diagnosed with amblyopia. Amblyopia has many potential causes, and it is important to determine what the cause of the amblyopia is and what treatment options are available. 

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Unfortunately, many studies in the past have assessed the treatment option of patching for improving visual acuity. This method is outdated and despite its ability to improve visual acuity, it does not always provide the best visual system. Vision is more than 20/20 and includes stereopsis (depth perception), accommodation, tracking, etc. In patients with amblyopia, other functional areas of vision may be decreased or not functioning at the best level possible. Patching is an option geared at a monocular approach, yet people are built with a binocular system. Newer evidence and studies are showing that a binocular therapeutic approach offers better responses to amblyopia. The improvements with a binocular approaching are more effective than patching alone. Patching may be utilized in a therapeutic plan monitored by the doctor. Patching used as a stand-alone treatment option there may be met with poor compliance leading to poor results. 

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By utilizing an approach to therapy to look at the whole visual system, vision therapy can improve not only the visual acuity but other areas of vision. These include, but are not limited to, improved tracking skills when reading, accommodation (or focusing skills), depth perception, eye-hand coordination, balance and more! In addition to therapy, spectacle correction can yield great results. The doctors at Excel prescribe using the Best Binocular Plus Prescription (BBPP) and determine the best glasses to improve functional skills. 

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Is it really a problem with the muscle in strabismus?  Click to find out! (access to the original paper)

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Surgery and Vision Therapy? Please Read the Links Below: 

  1. https://visionhelp.wordpress.com/2019/05/03/developmental-optometry-pediatric-ophthalmology-collaboration-revisited/  

  2. https://visionhelp.wordpress.com/2019/11/14/the-sandwich-approach-to-vision-therapy-and-strabismus/ 

  3. https://visionhelp.wordpress.com/2023/01/18/can-pre-surgical-vision-therapy-enhance-the-outcome-of-strabismus-surgery/  

  4. To Cut or Not to Cut? Weighing Strabismus Surgery Referral 

  5. Note that a Cochrane reviewed database search was referenced. The data is unknown for the optimal age for when strabismus surgery should be performed. 

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IF YOU HAVE BEEN TOLD YOU HAVE A “LAZY EYE” OR STRABISMUS OR AMBLYOPIA, CONTACT EXCEL TODAY TO MEET WITH ONE OF DOCTORS TO DETERMINE AN APPROPRIATE TREATMENT OPTION FOR YOU! 

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References: 

  1. Tsirlin I, Colpa L, Goltz HC, Wong AMF. Behavioral Training as New Treatment for Adult Amblyopia: A Meta-Analysis and Systematic Review. IOVS 2015;56:4061-75 

  2. Li J, Thompson B, Deng D, et al. Dichoptic training enables the adult amblyopic brain to learn. Current Biology 2013;23(8):PR308-09 

  3. Hess RF, Mansouri B, Thompson B. A new binocular approach to the treatment of amblyopia in adults well beyond the critical period of visual development. Restor. Neurol. Neurosci. 2011;28(6):793-802

  4. Ibrahimi D, Mendiola-Santibanez JD, Cruz-Martinez E, et al. Changes in the Brain Activity and Visual Performance with Strabismus and Amblyopia after a Complete Cycle of Light Therapy. Brain Sci 2021;11(5):657  

  5. Hsieh YC, Liao WL, Tsai YY, et. Al. Efficacy of vision therapy for unilateral refractive amblyopia in children aged 7-10 years. BMC Ophthalmol. 2022;22;44. 

  6. https://www.covd.org/page/amblyopia (For more information and references!) 

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