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Posted on 07-08-2015

Adventures in Strabismus Surgery

If you’ve been to this website/blog before you probably know that I have a great deal of experience helping people with all types of vision problems, including strabismus. I have worked with many people who have had eye muscle surgery who still could not keep their eyes looking straight and/or working together properly even after one or more surgeries. Vision therapy has helped many of these people use their eyes together better, which is what really helps keep them looking straight. I have helped many very young people avoid the need for strabismus surgery thanks to vision therapy. Strabismus surgery is not nearly as successful as vision therapy at keeping the eyes working together properly, or even for keeping the eyes looking straight over time. It is frustrating to me that there is still such division between those who do vision therapy and those who do surgery.

You don’t have to look far to realize that eye muscle surgery is more art than science. This is in part because adjusting the position of one or more eye muscles is usually not enough to change the performance (and therefore the appearance) of the two eyes. I just came across an article published in the Brazilian Journal of Ophthalmology in August 2014 entitled, A major problem in strabismus and its possible solution, began this way:

One of the challenges in strabismus is to guarantee stability of the surgical
corrections. Re-surgeries are often required even after careful diagnosis,
planning, and execution. Several factors contribute to this undesired outcome
and the existing management strategies are ineffective.

This is all very true…up until the last phrase, “the existing management strategies are ineffective.” While it may be true, or at least close to it, that management strategies provided by ophthalmologists/surgeons are ineffective, it is not true when one includes vision therapy as a management strategy. And why wouldn’t vision therapy be included as a management strategy for strabismus? Particularly after eye muscle surgery has been performed and the eyes are still not straight or working together properly? It is because the medical community is apparently willing to try anything other than vision therapy when it comes to treating strabismus - whether before or after eye muscle surgery. You might be curious what the latest suggestion is.

This article, written by the Department of Ophthalmology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil, investigated a new attempt to keep the eyes cosmetically straight after strabismus surgery. The author(s) stated that there is an above normal tendency of a surgically straightened eye to drift out of position. It is universally accepted that a large percentage of eye muscle surgeries must be repeated due to the brain’s inability to keep the eye(s) pointing where the surgeon intended. A number of patients seeking second opinions after being told that they or their child needed eye muscle surgery have told me, “The surgeon told us there’s nothing wrong with the eye muscle, but that’s how we fix it.” This means that even though the muscles are healthy, surgery is necessary to make the eyes look straight, if only temporarily.

Here’s what they tried in São Paulo, “Small magnets fixed to the orbit and metallic ferromagnetic elements fixed to the sclera to cover a suitable extension appears to be the best method for providing starting and sliding friction to the oculomotor system.” In plain language, they attached small magnets to the orbit of the eye while also attaching small bits of magnetic substance to the white part of the eye. They determined this to be the best method for managing undesirable slippage of the eye after surgical re-alignment.

I don’t know about you, but this seems like something approaching desperation to me. It’s such a shame that most surgeons remain unwilling to coordinate treatment with behavioral optometrists in treating strabismus. Behavioral optometrists know that sometimes eye muscle surgery is necessary for people with strabismus. We are not opposed to recommending surgery when we think it will help the person. Unfortunately very few surgeons are willing to include vision therapy in their treatment strategies. I keep hoping this will change, but in the meantime I wrote a book to help people get the most complete information available on strabismus, eye muscle surgery and vision therapy. Though I work with people of all ages the book is entitled A Parent Guide to Strabismus, Eye Muscle Surgery and Vision Therapy. It contains valuable information for anyone involved with the prospect of eye muscle surgery.

Also, my case report (a version of which appears in my book) on an 86 year old woman who absolutely refused to have surgery for her crossed eye was included in the latest publication from the Optometric Extension Program Foundation. The book is entitled Vision Therapy Success Stories From Around The World. This book is intended for students and new practitioners and includes authors from across the United States, Puerto Rico, Nepal, Australia and South Africa. Behavioral optometrists are providing vision therapy all across the globe. To find a behavioral optometrist near you contact OEPF.

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