Cross-eyed age start limit

Anyone knows the age limit a child needs to have fixed his/her
eventual natural cross-eyed condition?
Thanks in advance, Looker

 

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

 

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

 

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

 

Thanks for traing to help, Otis and Nipidoc. But, please, don't fight.
That is not the objective of my post.
Looker

 

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

Looker

 

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

 

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."

 

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

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