Thoughts/experience with vision therapy for a child's strabismus?

March 18, 2021 3:57 AM

This is for a child (5) with mild intermittent strabismus in both eyes.

My daughter (5) has intermittent strabismus that is worse in one eye than the other. That said, it's pretty mild and even if you knew her, you wouldn't necessarily notice it. (I notice it all the time though and it is instantly obvious to eye doctors.)

She was a very late talker, but is in the "normal" range now so I've always wondered if that was linked to eye difficulties. That said, she rides a bike without training wheels, and seems good at climbing, etc., reads well for her age, and had a normal OT evaluation a couple of years ago.

We are under the care of a specialist eye hospital, but all that really happens is we go in every few months, they say her vision is fine (i.e., she can see well, even with the strabismus), and that if it gets worse, they can do surgery.

I've read about vision therapy and exercises, but the eye hospital doesn't seem to put any stock in them at all and don't offer it. But it's got to be worth trying right? Or is it just made up? Surgery seems so extreme. It is expensive (not in the US) and time-consuming, though, so I'd love some experiences or links to evidence from the hivemind before we pursue it.

posted by heavenknows to Health & Fitness (11 answers total)

Vision exercises are probably not helpful, but harmless.

I was born with severe amblyopia and despite a lot of intervention and training as a child I continue to be clinically blind in my left eye, so I am dubious in its efficacy. I have the ability to see light, colour, and very vague shapes, but have no depth perception and terrible peripheral vision on my left. I cannot see anything coming at me from the left, and used to have a sign at an old job saying "if you can see this, I can't see you" to stop people coming to my desk and waiting for me to acknowledge them :)

My training included strengthening exercises, blurring or blocking my good eye, and using strong magnification alongside the exercising and blocking to try and force my bad eye to get stronger and work better, and encompassed almost the entire year. At 6 I spent a week at the hospital with intense intervention to try and get my bad eye to function better. While the interventions were actively happening, there was a little improvement, and I could read giant words, with enormous glasses, with an enormous magnifying glass, but the moment the active interventions stopped, it all went away.

I found the book Fixing My Gaze by Susan R. Barry quite interesting and saw a very mild improvement using her exercises with shapes having a tiny bit more clarity but not being even close to clear, and as soon as I stopped the exercises the improvement went away.

We may not share a condition, but this has been my experience as a child and an adult with vision therapy. The level of consistency and work involved for such small improvement really hasn't been worth it.
posted by daysocks at 5:11 AM on March 18, 2021

I have voluntary intermittent strabismus (exotropia) and did about a year of vision therapy in fourth grade (so around age 9). Frankly, I don't know if it was useful. It definitely made my eye muscles super strong - for example, I could cross my eyes for probably 5+ minutes before they got sore - but it didn't correct my strabismus on its own.

For me, when my eyes are focused on anything, they're aligned - but when they defocus (including when they're closed) one eye still "drifts out". Like breathing, I can control it voluntarily if I want to but I usually don't spend any time thinking about it. It's not a problem for me at all - I do have double vision when they're not focused, but I can snap that right back in and it's not uncomfortable. Occasionally I even take advantage of it for the extra peripheral vision! I know every case is different, though, and various eye doctors have remarked that my level of voluntary control over it is pretty strong. I don't know if that had anything to do with vision therapy. I will say that opthamologists I've seen as an adult seem happy that I tried vision therapy, at least in a "it was worth trying" kind of way.

The thing that did end up "fixing" my strabismus was when, only after my vision therapy, I went to a regular optometrist and got contacts for my myopia (not prisms, just regular ol nearsightedness glasses) and all of a sudden my eyes finally had things to focus on. Previously, the doctor associated with the vision therapy practice (optometrist? opthamologist? I'm not sure what she was) had said I needed to wait until vision therapy was over to get glasses, then when it was over, she purposefully underprescribed my glasses so that my eyes would have to "work and stay strong". Even though I admit I don't fully understand the clinical underpinnings, and perhaps that was reasonable, it still makes me angry, because I still couldn't see and I don't know how vision therapy would have gone if I'd actually had far-away things I could focus on. Plus all the impacts on my daily life of not being able to do things like see the board in school. It took another year before I saw a regular optometrist and got a regular prescription, for which I am very grateful. I'm a bit skeptical of the vision therapy practice I went to specifically because of that.

I will also note that I HATED doing it at the time. Not because it was that painful - it wasn't - but because sitting down to do half an hour of practice of anything every day can be kind of painful for a kid. I remember a LOT of power struggles with my parents over it. I don't know how that would have been if I were younger.
posted by mosst at 6:12 AM on March 18, 2021 [1 favorite]

I had this as a child! I don't know if this will be helpful because you are asking about exercises, but I had the surgery and it was totally fine. Looking back, it was probably harder for my parents than me. I was 8 and I thought it was all super cool (I got a box of cookies all to myself! And new pajamas!! And when I got back to school I told my friends that the doctors popped my eye out and cut it open!!!!) I had to wear an eye patch on the way home from the hospital but that was about it. Apparently I have a little scar on my eyeball, because opticians ask me about it. Now I'm an adult, you wouldn't be able to tell. When I am very tired I go ever so slightly cross eyed, but no one notices other than me. My vision is fine.
posted by EllaEm at 6:15 AM on March 18, 2021

I have a friend whose child had several surgeries and years of vision therapy. I think in combination it helped quite a bit with his convergence insufficiency, but he developed a huge resistance to the therapy - hours and hours of power struggles. One night he said he didn't like seeing depth and he was deciding not to do it. So...I don't know if that's helpful. His vision did improve. It was at the cost of a lot of family time and a lot of arguing. But what I took away from it was that vision therapy can work as long as the child's engaged.

For my own child, he had severe cataracts develop (we missed an annual physical when he was 3, don't do this) at a critical stage. His depth perception did develop but he has a few deficiencies left - he has reversals and his spelling is a atrocious, and for reading sometimes his tracking is off and he has to backtrack (me too, so I don't consider this an alarming situation, but it is a visible concern.) We paid for the vision therapy evaluation which was a couple of thousand dollars here, and did some visual integration therapy. We didn't see much improvement compared to the leaps my son made in the 6 months after his surgery and ultimately we decided the time and effort would be better spent just - doing things that used his vision, outdoors where possible and indoors with books and games.

I think the problem for me was and still is...you want your child to have the best sight possible, but with vision therapy no one could really help us pinpoint what was possible, just that there were deficiencies, and for my kid anyway, he was getting the message that he wasn't trying hard enough which...especially now that I'm more aware of the social aspects of disability, I think was really not great.

In both cases the hospital eye clinic (our kids were at the same one) did not think vision therapy is a proven therapy, nor did our insurance so it was all out of pocket.

My son can ride a bike, read, write although as mentioned his spelling is bad and he still sometimes reverses a few letter, and I don't think surgeon is a career option for him. I think if you consider spell check assistive technology he'll be using it for a long time.

I really don't know what to tell you, and I hope this doesn't muddy the water too much.
posted by warriorqueen at 6:16 AM on March 18, 2021

Another thing to add - my depth perception is just fine. I know that's an issue for some people depending on when in their neural development their alignment issues started, but mine seems completely normal. So if that's something you're worried about, I would watch your specific kid but know that it's not always an issue.
posted by mosst at 6:18 AM on March 18, 2021

My younger brother had amblyopia as opposed to striabsmus; it was diagnosed when he was about four or five. They were able to fix it by having him wear eye patches for a couple years - first on the "lazy" eye, to give it a break, and then on the "good" eye to get the "Lazy" one in shape. He also wore glasses for most of his childhood, with a corrective lens only for the "lazy" eye. But by the time he was an adult he didn't even need that.

And my father came up with a great way to make the eyepatch more appealing to my brother.
posted by EmpressCallipygos at 6:41 AM on March 18, 2021

I had vision therapy as child when I was maybe 7-8, following two surgeries for strabismus at 3 and 5. As far as I remember, this was a very boring and essentially useless experience, I ended up feeling very frustrated at not being able to "fix" my lack of depth vision and it was totally demotivating, not sure how long I did it for but someone must have decided this isn't worth doing it anymore. I also wore an eyepatch as some other posters mentioned, but that did not resolve issues. I'm an adult now in mid-forties, have worn glasses all of my life, still have a lazy eye, gets worse if I am tired, and my 3D vision is mostly non-existent. But that doesn't really affect me at all in everyday life. I was told by a doctor when I was 18 that I could have another surgery to correct the "lazy eye" further but I wasn't that bothered and I'm still not bothered.
So I'd say, having surgery isn't the end of the world (it did correct the worst aspects of strabismus for me), vision therapy is probably not all it's cracked up to be.
posted by coffee_monster at 6:55 AM on March 18, 2021 [2 favorites]

Mr. gudrun had vision therapy as a kid. I don't know that it really did much good at all. When I met him when he was 20, his strabismus was still present and noticeable to him. When he was in his 30s, things actually started getting worse, with one eye drifting off and him really having to work to bring it back, especially when he was tired. He wound up getting the surgery (they needed to do both eyes), which pretty much fixed things and he is now in his 60s and all is still good.
posted by gudrun at 7:29 AM on March 18, 2021

I had not heard of vision therapy. I say this as someone who had strabismus surgery as a kid, and my son has had 2 strabismus surgeries in the last year (and may need more). My case was less severe, surgery + eye patch fixed that issue (I have other issues and wear glasses still). My son's was quite severe. Surgery has made a big difference. He's had no other therapy other than wearing glasses. I also wouldn't consider surgery time-consuming. It's an outpatient procedure. The worst for us was the eye drops/ointment required after, but my son is a toddler so that was never going to be easy.

Basically, I'd trust what the docs say. Get a 2nd opinion about the necessity of surgery. Our experience with surgery has been positive.
posted by disaster77 at 9:24 AM on March 18, 2021

Response by poster: Hmm, this makes me inclined to skip it, at least for a little while. I foresee big battles with that much home-practice (or a lot of candy as bribes!) I may take her in for a consult just to see what they have to say, but will otherwise stick with the eye hospital. Would love any other views, and thanks again!
posted by heavenknows at 11:04 AM on March 18, 2021

I had intermittent strabismus as a child, did about a year of vision therapy when I was 8 years old (39 years ago), and was able to avoid surgery.

I was motivated to do therapy because half of it involved watching TV - with prisms and/or colored filters, but still TV, which was not something I was allowed to do much.

I can still deliberately un-align my eyes, but it doesn't happen to me involuntarily. Before my year of vision therapy it was involuntary and frequent. I had no depth perception, and now I do. I 100% attribute the improvement to therapy.
posted by Kriesa at 1:33 PM on March 18, 2021