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by Donald J. Getz, O.D., FCOVD, FAAO

THERE ARE MANY ALTERNATIVES to be considered in deciding the treatment program for patients with strabismus and amblyopia. The first alternative to be considered is what is likely to happen if nothing is done. Many patients have been advised by well-meaning doctors, friends and relatives that the child might grow out of the problem. This is practically never the case. Unless remediation is attempted, the problem will either remain the same, become more deeply imbedded, or adaptations will take place which will make Vision Therapy at a later date either more difficult or, perhaps, even impossible to conclude successfully. The child simply does NOT grow out of the problem.

SURGERY is an alternative which is frequently considered. The best "cure" rate that can be claimed by surgeons is a cure rate of eleven per cent. This eleven percent figure includes both a cosmetic and a functional cure (that is, the eyes appear normal and straight and function binocular vision is developed or recovered). Generally, when surgeons use the word "cure" when talking about strabismus surgery, they are referring to a cosmetic cure only; that is, the eyes APPEAR straighter. Since surgery generally does not provide a functional cure so that the eyes are being used together, the results are rarely permanent and repeated operations must be performed which, in turn, can promise no permanent functional result.

IN ADDITION to this relatively low cure rate, there are other negative side effects of eye muscle surgery. In the United States alone, there are over twenty deaths per year occurring while eye muscle surgery is being performed. These deaths are due to the ocul-cardiac reflex. This is the same reflex which will cause the pulse rate to slow when pressure is exerted on the exterior of the eye. Under conditions of anesthesia, this same pressure on the muscles on the outside of the eyes can result in a cardiac arrest. There are still other side effects frequently observed after eye muscle surgery. Often, the result is one eye being made higher than the other or rotated slightly in position. If either of these two conditions should result, it will make it more difficult for Vision Therapy (visual rehabilitation) to be successful. Finally, the psychological trauma to the child should be considered as another possible side effect of eye muscle surgery. The hospitalization, anesthesia, separation from parents and possible pain could do irreparable damage to the young child.

THE RESEARCH on the results of Optometric Vision Therapy for the problems of strabismus and amblyopia shows a considerable higher cure rate. Dr. William Ludlam, at the Optometric Center of New York, showed a "cure" rate of seventy-three percent. His definition of cured included both a cosmetic and a functional cure so that the patient was truly binocular, the eyes were being used together and were straight under all conditions.

A STUDY was done by Dr. Gary Etting to determine the cure rate that was obtained by Optometric Vision Therapy in private practice. He used the same criteria for "cure" as used by Dr. Ludlam in his study. He found that the cosmetic cure AND functional cure rate in this unselected sample was 78%.

A MISCONCEPTION generally exists that strabismus is caused by a "weak" muscle. This is almost never the case. It has been known for many years that the muscles on the outside of the eyes (extraocular muscles) are in the order of one hundred times stronger than they need to be. Consequently, Vision Therapy does not consist of exercises designed to make a muscle stronger. It is a process whereby the faulty manner in which the patient has learned to team his eyes is broken down and the adaptations to the problem are thus eliminated. The patient is then taught to properly team his eyes together proceeding sequentially through all the steps that a child should go through in order to achieve normal eye teaming. First, each eye is provided with experiences so that skills are made equal with each eye. Next, the suppression or turning off of one eye is eliminated and finally, the two eyes are taught to team together. This process generally takes from three months to one year depending on the severity of the problem.

It is a DEFINITE ADVANTAGE to the person to have two eyes functioning rather than just one. With two eyes, a person will have better depth perception and a full field of view which is not limited as it would be on one side if one eye were not being used. Also, he will very likely achieve a faster reading speed with greater comprehension. There are many other advantages too numerous to mention. The visual system (which creates visual perception and vision) is an information processing system and it stands to reason that more raw data is provided to the brain in a two-eyed (binocular) person than in a one eyed (monocular) person. Naturally, when the eyes are functioning together they will look and stay straight.

STRABISMUS and amblyopia are conditions that exist in the general population much more commonly than is generally suspected. Both conditions, however, respond favorably to the proper therapy and can be eliminated in both child and adult.

The private practice of Drs. Getz and Etting is located in Southern California. There are many high quality vision care practices which specialize in non-surgical (and, in some cases, surgical) treatment of strabismus throughout Southern California and the United States. See our Referral Directory: Find a Pediatric Eye Doctor.

To locate an eye doctor who provides comprehensive pediatric vision examinations and treatment, including Vision Therapy, request a referral through our Referral Directory: Find a Pediatric Eye Doctor.

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