exotropia vision therapy for toddler

Hi,

Does anyone have information on vision therapy for a 2 1/2 year old
with intermittent exotropia ? We consulted three doctors and two of
them told us that surgery was the only option. We are about to go
with the third one for therapy. I have heard of success stories for
older kids (over 6 yrs). Any info on exotropia/strabismus related
vision therapy for toddlers is welcome. thanks.

amar

 

Depends on the amount of time the eyes are exotropic. If less than 50% of
awake hours, generally best left alone, as they eyes have enough time
together to learn how to work together.

If equal vision (ie either eye can go out), and over 50%, over-minus glasses
may be useful. The additional accommodation induced brings accommodative
convergence into the act, and this often reduces the angle out, by inducing
some amount of angle in. Virtually never controls it totally, but may reduce
it sufficiently so as to postpone or avoid surgery. It is just crutch to
hold off surgery. However, some kids need to wear glasses for vision reasons
anyway, and if the addition of the overminus helps them long term, then
there is not reason to discontinue glasses later on - these kids sometimes
avoid getting surgery.

If unequal vision, part-time patching may be useful to equalize the eyes, at
which time the eyes may then have btter control. Too much % of time patching
may bring out the exotropia more, so care is needed.

Surgery is generally reserved for those cases where the above does not work.
Surgery always needs to overcorrect the angle at the beginning for it to
work well once healing has occurred. The problem is the the overcorrection
may stay on, and cause the eyes to be slightly crossed, which is constant,
and causes loss of fusion. This is worse than intermittent exotropia, where
fusion is still occurring. This problem is less when surgery is performed
after age 5 or so, assuming surgery can be delayed because the eyes are
straight over 50% of the time. IF this cannot be delayed, then surgery can
be done at any time.

Intermittent exotropia also responses less well to surgery than almost any
other strabismus. The eyes may get surgery, and still show a tendency to
drift out. I have seen cases where the first surgery was adequate, causing
sufficient angle in right after surgery, and still drift out almost to where
it was before surgery. A second surgery then tends to be more successful.
Other cases go through a seesaw situation- first out, then in, the out, etc,
with each succeeding surgery.

Note we are talking about intermittent exotropia. Constant exotropia,
particularly congenital, is operated on at an early age, and does not
respond to the overminus glasses trick usually.

It is hard to generalize for all cases- they need to be examined and handled
on an individual basis.


David Robins, MD
Board certified Ophthalmologist
Pediatric and strabismus subspecialty
Member of AAPOS
(American Academy of Pediatric Ophthalmology and Strabismus)




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David Robins, MD wrote:

These fully certified doctors go on telling the same lies as they did in
Dr. Bates times.

When will you stop to destroy people and raise your dirty hands asking
guidance to those who understand better than you?