Cross-eyed age start limit

Discussion in 'Eye-Care' started by Looker, Oct 3, 2003.

  1. Looker

    Looker Guest

    Anyone knows the age limit a child needs to have fixed his/her
    eventual natural cross-eyed condition?
    Thanks in advance, Looker
     
    Looker, Oct 3, 2003
    #1
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  2. Looker

    Otis Brown Guest

    Dear Looker,

    There are normal recommendations for you.

    1. Visual Training

    2. Cut the muscle.

    Does the child show ANY ability to fuse
    the two eyes? If she is small, pick her
    up and rotate her back and forth. If her
    eyes follow the motion -- there may be
    hope.

    I would take her to a an optometrist (behaviorial)
    who offers her VT.

    If the childs "turned in" eye is always in that
    position, then probably there is little more
    that can be done. But the muscle can be
    cut at any time. If so, the eyes can be
    straightened -- but they will not fuse.

    Since I had a slight amount of "squint" (i.e.,
    eye "drifts out" I do have some practical
    experience.

    Since I could alway "fuse", if I paid attention
    to it, I received Visual Training. I am
    certain that the VT was frustrating for
    my Visual Trainer -- as it was for me.

    But after some time using a stereo scope, I
    could train my eyes to fuse continuously.

    [I did have the muscle cut -- but I think
    it was a waste of money and time. But
    that is the difference of opinion, and
    the frustration with this issue.]

    Best,

    Otis
    Engineer
     
    Otis Brown, Oct 4, 2003
    #2
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  3. Looker

    Dr Judy Guest

    Not sure what you mean by "eventual natural cross eyed condition".

    Infants do not develop full motor control of the eye muscles until around
    nine months of age. If an eye turn is still noted with full refractive
    correction after 12 months, then it should be corrected, (likely by surgery,
    but the child's eye doctor is best to determine this) as soon a possible to
    prevent amblyopia. The longer you wait, the lower the chance of good
    vision. For eye turns that develop later, correction before about age 6 is
    desired, correction between age 6 and about age 12 will have limited sucess
    in treating amblyopia and correction after age 12 will likely have no
    ability to prevent or reverse amblyopia.

    Dr Judy
     
    Dr Judy, Oct 4, 2003
    #3
  4. Looker

    Otis Brown Guest


    Dear Nipidoc,

    I gave suggestions from PERSONAL EXPERIENCE. The
    man reading it can understand what I said and make
    is own decisions. I IDENTIFIED myself as
    an ENGINEER -- get it!!!

    I am certain he can understand that intent -- even
    if you do not.

    Please note that I referred him to an ophthalmologist
    for final resolution to this issues -- so that
    he could be intellectually prepared to understand
    the nature of options that are available to him.

    I think that is fair -- even if you do not.


    Best,

    Otis
     
    Otis Brown, Oct 5, 2003
    #4
  5. Looker

    Looker Guest

    Thanks for traing to help, Otis and Nipidoc. But, please, don't fight.
    That is not the objective of my post. :(
    Looker
     
    Looker, Oct 6, 2003
    #5
  6. Looker

    Looker Guest

    Thanks, Judy.
    Sorry for not making me clear, but your answer was exactly what I was
    looking for. :)

    Looker
     
    Looker, Oct 6, 2003
    #6
  7. While you can "cut the muscle" at any time, getting the eyes straight beofre
    age 2 (closer to age 1) may in fact get some fusion. Peripheral, in most
    cases, but central in some. Occasionally, even get some high-grade fusers
    with good stereopsis, but this is not that common. Waiting until an older
    age pretty much guarantees lack of such success.


    Otis's recommendation to see if the eyes track (follow) is unrelated to
    fusion, where the eyes are straight part of the time and use both images
    simultaneously. Can't determine that from Otis's test. He is just testing if
    the eyes are capable of following movement, indicating the baby is not
    blind. (This is part of the testing in babies where vision may be absent.)


    Otis mentions his fusion issues, with him having drifted out. Intermittent
    exotropia (going out) is a totally different animal from esotropia (drifting
    in. the central adaptations made are not the same at all. Esotropia has a
    much more profound effect on fusion than does intermittent exotropia.
    Intermittent exotropia is one of the best indications for visual exercises,
    and this condition has about the poorest success with surgery, because even
    more so than other strabismuses, this is all caused by abnomrally generated
    muscle signals, and it is persists oftentimes even after generous amounts of
    surgery. In the young age group, the "success" of a single surgery to
    greatly reducing the frequency of out-turning is probably less than 50-60%.
    Comparing to infantile esotropia, where the success rate (ie angle less than
    8 prisms in or out, a generally accepted guideline) is about 85% or so.



    David Robins, MD
    Board certified Ophthalmologist
    Pediatric and strabismus subspecialty





     
    David Robins, MD, Oct 7, 2003
    #7
  8. Looker

    Otis Brown Guest

    Dear "Looker",

    Here is some judgment from Dr. Ray Gottlieb, OD, Ph.D.
    for background on eye-turn.

    Obviously opinions vary on this subject.

    Best,

    Otis
    Engineer

    ****************

    13. Is it true that there are certain conditions, like lazy eye, where
    the patient is too old, or it's too late to intervene with vision
    therapy?
    First, let's define the terms. What the public knows as "lazy eye" is
    technically amblyopia. A diagnosis of amblyopia means that one eye
    doesn't see as clearly as the other eye even with proper glasses or
    contact lenses. Amblyopia can occur with or without strabismus, which
    is a crossing or turning of the eyes. Strabismus is sometimes
    attributed to one or more weak eye muscles, however the problem is
    more often due to a defective neurological signal to the involved
    muscle(s) rather than to an actual muscular abnormality.

    Secondly, allow me to emphasize that, in regards to amblyopia and
    strabismus, the eye muscle training benefits of vision therapy are
    medically proven. There is no controversy there. Where eye doctors do
    not always agree is in regards to this question you have asked. There
    are eye surgeons who promote the idea that if a child has an eye turn,
    you must operate by age two to get meaningful results, and if there is
    amblyopia, or lazy eye, intervention of any kind is only meaningful
    before age 6 or 7. There are many scientific articles in optometric
    journals which prove that it's never too late to treat a lazy eye, but
    I'd like to refer to an study by an eye surgeon.

    In the American Journal of Ophthalmology, von Noorden, a well-known
    strabismus surgeon and researcher reviewed the records of 408 patients
    who had eye turns shortly after birth, and divided their surgical
    outcomes based on age at the time of surgery:


    AGE Surgical Outcome Percentage
    4 mos.-2 yrs. Optimal 24%
    Desirable 4%
    Acceptable 36%
    Unacceptable 36%

    ------------------------------------------------------------------------

    2 yrs. - 4 yrs. Optimal 15%
    Desirable 5%
    Acceptable 44%
    Unacceptable 36%

    ------------------------------------------------------------------------

    Older than 4 yrs. Optimal 16%
    Desirable 14%
    Acceptable 42%
    Unacceptable 28%


    Re: surgical treatment, the data above shows that useful results can
    be obtained by intervening after age 2. The data also shows that there
    should be no rush to go to surgery after the age of 2, because the
    outcomes don't differ that much after that age. By the way, the
    positive outcomes measured above include cosmetic improvement ONLY.
    Vision therapy aims to do more than simply straighten the appearance
    of the crossed or turned eyes. It aims to help patients develop useful
    binocular (two-eyed) vision.
    You can learn more about eye muscle surgery as a treatment for lazy
    eye or eye turns, etc. by visiting www.strabismus.org, the web site of
    Dr. Jeffrey Cooper.

    Re: vision therapy treatment, you'll always get the best results if
    you intervene at a young age, IF you can get a child's cooperation.
    But, children have little motivation to cooperate. It's been proven
    that a motivated adult with strabismus and/or amblyopia who works
    diligently at vision therapy can obtain meaningful improvement in
    visual function. As my patients are fond of saying:

    "I'm not looking for perfection; I'm looking for you to help me make
    it better". It's important that eye doctors don't make sweeping value
    judgments for patients. Rather than saying "nothing can be done", the
    proper advice would be: "You won't have as much improvement as you
    would have had at a younger age; but I'll refer you to a vision
    specialist who can help you if you're motivated."
     
    Otis Brown, Oct 9, 2003
    #8
  9. The reason for surgical intervention in infantile esotropia before age 2 is
    not based on the "acceptable" cosmetic outcome percentage or getting
    "meaningful results".

    The reason in operate early is that it has been shown that this increases
    the likelihood of at least peripheral fusion (eye-to-eye cooperation that
    helps maintain alignment), and occasional bi-foveal (central) fusion. The
    results of central fusion is less successful, and is greater when operated
    at a younger age, whence the recommendation to operate around age 1, when
    the alignment is stable and can be more accurately measured than in 6 month
    olds.

    Some mavericks are suggesting operating before age 3 months, but most will
    not, due to the condition sometimes disappearing on its own, and being
    unstable, inaccurately measured angles.

    Yes, you CAN operate at any age and get acceptable cosmetic alignment as
    mentioned below, even in adults.

    By the way, we do treat amblyopia these days as late as 10-11 years old in
    some cases.



    David Robins, MD
    Board certified Ophthalmologist
    Pediatric and strabismus subspecialty

    ______________________________________________
     
    David Robins, MD, Oct 9, 2003
    #9
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