Garriott RS, Heyman CL, Rouse MW.

Role of optometric vision therapy for surgically treated strabismus patients.

Optometry and Vision Science, April;74(4): 179-184, 1997.

BACKGROUND: Occasionally, co-management involving both optometry and ophthalmology is needed to optimize treatment outcome for the strabismic patient.

METHODS: JB, a 47-month-old consecutive esotrope presented to our clinic (Southern California College of Optometry). Two previous attempts to surgically correct her exotropia had failed and the parents sought another treatment approach. We recommended optometric vision therapy (VT) to improve sensorimotor fusion before any further surgery. After 31 VT sessions (bi-weekly for a time, then weekly), before a third scheduled surgery, sensorimotor fusion was good in the amblyoscope, but unstable with neutralizing prism in free-space. We recommended surgery be postponed, but the family proceeded. Esotropia recurred with constant suppression. After additional VT, JB developed stable sensorimotor fusion and random dot stereopsis in free-space with neutralizing prism. A fourth surgery was then performed resulting in esophoria at all distances with good sensory fusion.

RESULTS: Twenty-one months postoperatively, JB remains nonstrabismic with good sensory fusion.

CONCLUSIONS: Clinicians should understand the roles and limitations of available treatment options. Surgery reduces the magnitude of the deviation, whereas optometric VT (vision therapy) provides the unique role of establishing normal sensory processing.