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Vision Therapy

This response submitted by Elizabeth Lund on 5/31/97.

These are my comments regarding the choice of Vision Therapy vs. surgery. Vision Therapy is a viable alternative for strabismus. It can be hard work, though. I would recommend two consultations [get that second opinion!]: one with a pediatric ophthalmologist and one with a behavioral optometrist.

The argument that surgeons weaken a muscle deliberately to straighten the eye is horrendous. The problem in strabismus is NOT a muscle weakness, it is neuromuscular [the signals or instructions that the brain sends to the muscles]. For example, ask the surgeon to explain why when he covers the patient's "good" eye, the other eye suddenly straightens.

Compare the treatment of binocular dysfunction [strabismus, crossed eyes, wandering eyes, etc.] to the treatment of speech problems. Does a surgeon cut someone's tongue because they lisp or does a speech therapist attempt to re-train the person's neural pathways? And, yes, the brain is plastic and can be re-trained. Otherwise, there would be no hope for stroke patients in rehab today.

There are cases where surgery is necessary, but even then the patient should do therapy in conjunction with the surgery. Two important questions any person should ask both the surgeon and the optometrist is "what are the goals of this treatment?" and "what is the criteria for success?" Most surgeons only strive for cosmetic improvements [straighter looking eyes], not functionality [improved vision). Also, it is critical to ask the surgeon how many surgeries they average on each patient. It usually isn't just one!!!

My recommendation is to try Vision Therapy. If it doesn't work then surgery is a possibility. On the other hand, surgery is permanent and if doesn't work, it is a real mess to go back and fix it with therapy.

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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