Eye Turns and Vision Therapy

Strabismus refers to a condition in which a person’s eyes do not both look to the same place at the same time. It is also referred to as “crossed eyes” or as an eye turn. Strabismus usually occurs in people with difficulty controlling their eye muscles, and also in very farsighted people. 

Strabismus, however, does not refer to just one thing.

Here’s an easy, factual definition of Strabismus from the American Optometric Association:

“Strabismus usually develops in infants and young children, most often by age 3. But older children and adults can also develop the condition. People often believe that a child with strabismus will outgrow the condition. However, this is not true. In fact, strabismus may get worse without treatment. A doctor of optometry should examine any child older than 4 months whose eyes do not appear to be straight all the time.”

You may be seeing signs of Strabismus in your young child. You also may be concerned, though, because Strabismus is affecting you. Though we see Strabismus most commonly in younger children, it can develop in adults and can also go untreated for years, in some cases.

Some of the symptoms of Strabismus can be:

• Eyes that appear misaligned 

• Eyes that do not move in unison

• Squinting often, especially in bright sunlight

• Frequent blinking, especially in bright sunlight

• Head tilting while reading or observing surroundings

• Poor depth perception

• Double vision

Strabismus is not a “one size fits all” condition, since it encompasses many different eye behaviors and affects both adults and children. Luckily, a combination of vision therapy and other treatment approaches can help people of all ages see better, process visual information more clearly, and lead a happier life. 

Types of Eye Turns

Doctors classify Strabismus by the direction the patient’s eye turns.

The classifications include:

• Esotropia: inward turning.

• Exotropia: outward turning.

• Hypertropia: upward turning.

• Hypotropia: downward turning.

From the Review of Optometry:

“While the more common type of strabismus in children is esotropia, exotropia is found in about 20% of young patients with strabismus. Parents of children with exotropia often present stating that their child’s eye, or eyes, drifts out. This can happen if the child is looking far away and not concentrating visually, if they are reading [too near the material], or in both cases. Exotropia can be intermittent or constant and monocular, alternating or binocular.”

We see all types of Strabismus in both children and adults, simply because eye turns are interesting phenomena that can occur at any stage of life and can go in different directions. Regardless of the deviation type, it is important to have an assessment with a residency trained eye-care provider to determine the type and cause of eye-turn.

Eye Turn Treatments and Vision Therapy

Some eye-turns can be associated with neurological conditions that can be life threatening, while others just need an appropriate pair of glasses. Quite frankly, a Strabismus (eye turn) can be a daunting thing to assess for some providers because of the neurological involvement. That is why it is important to see a provider who is comfortable with working with a Strabismus.

Treatment options for exotropia are not always the same. There are varying causes and degrees of strabismus, and as a result different treatment approaches (or combinations of treatment) can be prescribed. 

Treatments include:

• Glasses: With accommodative esotropia the brain contracts the muscles, pulling the eye inward. The use of glasses can often correct the eye alignment.

• Patching: The goal is to cover the “good” eye and make the “bad” eye work. In some cases this treatment approach can cause the eye turn to either increase or become more frequent.

• Surgery: This approach is often used to address cosmetic concerns. Surgery alters the outside eye muscles to “align” the eye. However, it is  not uncommon for the eye to move back out of proper alignment, resulting in additional surgeries.

• Vision therapy: Provides biofeedback to teach the brain and the eyes to work together (fusion). This process helps keep the eyes aligned and improve depth perception.

Several studies have begun to explore the use and effectiveness of biofeedback in the treatment of Strabismus. The mounting evidence of biofeedback enhanced vision therapy shows that integrating brain function and the visual system during therapy is highly effective. Study results have established that strabismus is not an isolated eye muscle problem, as was once believed.

An exhaustive study by Steve Leslie B Optom concluded:

“Optometric treatment of amblyopia and strabismus with lenses and patching, and in some cases vision therapy, is effective in many cases in achieving improved visual function to the high Flom criteria.”
It is advisable to seek out a residency-trained eye doctor, such as Dr. Ryan C. Johnson, who specializes in pediatric vision care or binocular vision rehabilitation; and is experienced in prescribing the full range of treatment option(s). 

A second opinion should be considered if an eye doctor recommends only one course of treatment, or is opposed to discussing all available treatment options.

If you, your child, or a loved one are struggling with Strabismus, you can request an appointment today,