The last topic we discussed regarded Strabismus and the different types of Strabismus: Constant, Intermittent, and Alternating Strabismus.  Today, I’ll be talking about how we as behavioral optometrists can use lenses and prism to help resolve strabismus along with vision therapy. 

Lenses:  We all know to some degree that lenses are used in glasses to help us to see better whether your nearsighted, farsighted, and/or astigmatic.  Well lenses can also be used to help alter the posture of one’s eyes (”how straight the eyes are”).  For instance, plus power used to correct farsightedness can also be used to relax posture.  In other words, allow a strabismic patient that has their eyes turning in change to straightening out and not turn in while wearing glasses.  Minus lenses used to correct nearsightedness can also be used to help bring the eyes in or “a flexing” posture.  In other words, when one’s eye is too relaxed or positioned outward, these lenses can be used to help the eyes converge (come in) to again straighten out the eyes.

Prism:  Prism is used to bend light in a certain direction, I won’t go into the optics of it, but basically it can be used to alter the direction of light.  In strabismic patients we use prism to relax the demand on their binocular system to maintain fusion or use your eyes together as a team (binocularity).  For instance, when one’s eye is turned out as in exotropia (a form of strabismus) we can use what we call base in prism to shift the light and resultant image out to where the eye likes to be thus giving the brain an opportunity to view the same target of regard or image at the same time out of both eyes.   As a result, it then becomes easier for a strabismic patient to fuse or bring the images together to form one; creating binocularity!  Base out prism is used to correct strabismic patients that have their eyes turn in aka esotropia.  Vertical prism such as base up and down are used to correct a strabismic patient that has an eye that is turned up or down.  Either way, prism is used to eliminate double vision as a result of strabismis and encourage binocularity.  When I use the term “base”  think of the base of a prism and then when I say base up, down, out or in, that refers to the direction the base is in when placed in front of the patient to use in their glasses.  Please take note that the glasses would not look like there was literally prism in them as cosmetically that would look a little weird (; It’s actually a measurement for the lab to cut the lenses a certain way in order to create the prismatic affect.

Vision Therapy:  Vision therapy involves doing exercises or activities in an attempt to develop awareness of binocualrity by teaching the patient what to see and feel when using their eyes correctly for functional binocularity!  We use prism and lenses to manipulate light and challenge the patient to establish and sustain binocualrity.  Vision therapy usually involves 1 hour sessions in office once or twice a week followed with homework for the patient to do every night at home in order to build those skills; practice makes perfect! 

All in all, lenses, prism, and vision therapy is a credible and equal approach to treatment of strabismus.  I encourage you to read more about vision therapy and the success stories that come about from doing it.  Surgery isn’t always the answer when it comes to strabismus and this is definitely a less invasive and/or traumatic approach to treatment vs. surgery.  Strabismis surgery is usually repeated in roughly 50% of cases so please consider vision therapy before surgery as an alternative to treatment since it could be the best decision you have ever made regarding you and/or your child’s vision.

Strabismus is a condition where a patient lacks binocularity or binocular fusion as a result of the eyes not “teaming together” correctly.  An example is when you notice someone that has one eye fixated on you while your talking to them while the other eye is looking in a totally different direction whether it be up, down, left, or right.  Some people refer this as being a “lazy eye”, but that is not necessarily the case.   Amblyopia or “lazy eye” is a condition in which the eye is not capable of seeing 20/20 no matter how good the prescription is for the eye and there is no pathology or disease entity to explain the vision loss.  These types of eyes can be rehabilitated to sometimes 20/20 along with functional binocular vision with the use of vision therapy.  Only a constant strabismus (eye affected is always turned away) can cause a true lazy eye or amblyopia.  In other words different forms of strabismus exist which are as follows.  A constants strabismus, and intermittent strabismus and even an alternating starbismus.  I will define all three  accordingly:

Constant Strabismus:  One of the patient’s eyes is always turned in, out, up, and/or down.

Intermittent Strabismus:  One of the patient’s eyes sometimes deviates in one of the previously mentioned directions.  This especially occurs when the patient is fatigued or tired.

Alternating Strabismus:  This is when the patient’s eyes take turns alternating the deviation present between the eyes.  In other words, one minute the right eye is deviated and then the next minute the left eye is deviated. 

My next blog will be a continuation about this topic but I’ll be discussing ways of treating this condition.  If this is noted with your child, have them see an eye care professional immediately as a sudden onset could indicate neurological complications, while a congenital or gradual onset should be treated also right away for a more favorable prognosis.  However, strabismus surgery isn’t necessarily the answer, but vision therapy is the answer for a lot of these affected patients.

80% of what children learn before 12 years of age is through their vision.  This fact explains the importance of having your child’s vision checked on an annual basis besides having your child’s vision checked as a toddler.   Only 4% of vision problems are detected through vision screenings at school and at the pediatrician’s offices when 25% of children have a vision problem.  A simple comprehensive eye exam with dilation is recommended to rule-out any refractive errors, ocualr pathologies, and binocular vision disorders.  Our eyes reveal a lot about our general health and help reveal systemic diseases and/or autoimmune disorders that can otherwise go undetected until far later when the condition has worsened. 

Some states have all ready passed laws that mandate eye exams for children before starting school.  This is a great thing since it helps us rule-out right away if vision is hindering the ability for a child to learn with the rest of his or her peers.  For instance, a lot of these kids are mislabeled with ADD/ADHD for instance when all they needed was a pair of glasses or a little vision therapy.  This would save our education system millions of dollars in unnecessary “IEP’s” and special needs therapy at school since all it was to begin with was a vision problem.

The message here is to take your children and even yourself to an eye care professional to rule-out any vision problems let alone any systemic conditions that might be going on that you were unaware of at that time.  Preventive medicine is a great concept, which can save you a lot of money in medical bills in the long run let alone one’s life when catching a potentially life threatening disease in its early stages.

Amblyopia (lazy eye) is the leading cause of preventitive blindness in children.  There are different forms of amblyopia that exist.

1. Refractive Amblyopia-  This is usually due to a high refractive error in one vs. the other (anisometropia) or sometimes both (isoametropic) if the refractive error is high in both eyes.

2. Strabismic Amblyopia- This is due to an obvious constant eye turn.  This is what most people think of when they think about lazy eye.  In other words the person involved has one of their eyes turned in, out, up, or down while the other eye is looking at you or whatever target the person is fixated on.

3. Form Deprivation Amblyopia-  This is a form of amblyopia that is a result of something interferring with the normal refraction of light in the eye.  Examples include a congenital droopy eyelid (ptosis) or congenital cataracts that interfers with the normal retinal image processing of the brain’s visual cortex.

All three types of amblyopia are treatable if caught early in the patient’s development.  In other words the onset of amblyopia is from 1-8 years of age, but if the condition is caught early in a patient’s life than the prognosis is much more favorable than when trying to treat the condition later on in life as an adult.  The reason for this is due to the plasticity of the brain at an early age.  In other words it’s a lot easier to teach a “new dog new tricks vs. an old dog new tricks” as the saying goes.  This means a child’s brain has a much easier time relearning things than if you try later on in life due to this critical development period of the brain that exists between 1-8 years of age.  

I encourage all parents to get their children’s eyes checked at 2-3 years of age in order to catch it early and treat it.   This way the condition is caught early enough before it becomes a “bad habit” in order to salvage single clear comfortable binocular vision.

Only 4% of children are detected to have a vision problem with school and pediatrician visual screenings.  When actually 25% of children actually have a vision problem. 

The message here is to have an eye care professional perform a comprehensive eye exam on your child at 2-3 years of age so that these potential visual conditions are caught early and treated before they become a real problem with the child’s ability to learn and perform daily functions.

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