What if my child’s eyes are crossed? Strabismus 411.

HELP! It looks like my child’s eye is turning in, or out or I’m not sure. What do I do? What is strabismus anyway?

Photo courtesy of mjtmail (tiggy) on Flickr

Photo courtesy of mjtmail (tiggy) on Flickr

Strabismus, or crossed eyes, is a condition in which both eyes do not look at the same place at the same time. It occurs when an eye turns in, out, up or down. Strabismus is classified by the direction the eye turns:
• Esotropia = Inward turn
• Exotropia = Outward turn
• Hypertropia = Upward turn
• Hypotropia = Downward turn

There are six muscles attached to each eye that control eye movement. Normally, the eyes work together so both eyes look at the same place at the same time. An eye turn may be visible when there are problems with eye movement control.
The eye turn may be present constantly or only at certain times such as when the person is tired, ill, or has done a lot of reading or close work. One eye or both eyes may alternate turning.

Proper eye alignment is important to avoid seeing double, for good depth perception, and to prevent the development of poor vision in the turned eye.

What causes strabismus?

There are many causes, including:

  • Eye muscle problems.
  • Problems with the nerves that transmit information to the muscles.
  • Trouble with the control center in the brain that directs eye movements.
  • General health conditions or eye injuries.

What are risk factors for developing strabismus?

  • Family history – Those with parents or siblings who have strabismus are more likely to develop it.
  • Refractive error – Especially a large amount of uncorrected farsightedness (hyperopia).
  • Medical conditions – Including Down syndrome, cerebral palsy, stroke or head injury.

How is strabismus diagnosed?
Strabismus is diagnosed through a comprehensive eye exam. Testing may include:

  • Visual acuity, or vision – “Normal” distance visual acuity is 20/20.
  • Refraction – Determine the appropriate lens power needed to compensate for any refractive error (nearsightedness, farsightedness, or astigmatism).
  • Alignment and focusing testing – How well the eyes focus, track, move and work together.
  • Examination of eye health – This includes the front and back of the eyes. Eye pressure is also evaluated.

Because vision may change frequently during the school years, regular eye and vision care is important.

How is strabismus treated?
There are several treatment options to treat strabismus, including:

  • Eyeglasses or contact lenses – For some conditions, glasses alone will align the eyes.
  • Prism lenses – Prisms align the images seen by both eyes, so the eyes can fuse or see the same image, restoring visual clarity and depth perception.
  • Vision therapy – Vision therapy trains the eyes and brain to work together more effectively.
  • Eye muscle surgery – Surgery may be able to physically align the eyes so they appear straight. A vision therapy program may also be needed after surgery.

What can happen if the eye turn is not treated?

Photo courtesy of jmoneyyyyyyy on Flickr

Photo courtesy of jmoneyyyyyyy on Flickr

Potentially an untreated eye turn can lead to amblyopia, otherwise known as lazy eye. Amblyopia is permanently reduced vision in one eye.

When does a child develop strabismus?
Typically strabismus develops in infants and young children by age 3. It may be present in older children and adults. Children do not “outgrow” strabismus.

Most importantly…
If detected and treated early, strabismus can often be corrected with excellent results. Eye examinations are important for all children and adults, starting at 6 months of age. If any eye turn is in question, schedule a comprehensive eye examination immediately.

~Melissa Barnett, OD, FAAO
California Optometric Association
http://www.eyehelp.org
http://www.coavision.org

Eye color – Did you know?

1) How is eye color determined?

   Eye color is determined by two distinct factors.

  • The pigmentation of the eye’s iris – The iris is a muscle and the colored part of the eye. The amount of melanin present determines eye color.
  •  The scattering of light in the stroma of the iris – Rayleigh scattering is a similar phenomenon that accounts for the blueness of the sky. Blue and green pigments are not present in the iris of humans or ocular fluid.

2) Does eye color change with age?

Photo courtesy of Javier Manso on Flickr

Photo courtesy of Javier Manso on Flickr

  • Yes. Most babies with European ancestry have light-colored eyes before the age of one. As a child grows, melanocytes produce melanin. Melanocytes are cells found within the iris of human eyes. Most eye color changes occur when the child is around one year old, however it can happen up to three years of age.
  • Eye color (lightening or darkening) may change with age. This occurs in 10 to 15 percent of the population. However, if your eye color changes dramatically as an adult, it is important to schedule an examination with your eye doctor. Eye color changes may indicate certain diseases, such as Fuch’s heterochromic iridocyclitis, Horner’s syndrome or pigmentary glaucoma.

 3) Is it possible to see emotions such as anger or love in the eyes?

Yes. Certain emotions can change both the pupil size and the iris color. Pupil size gets larger in dimmer lighting and smaller in brighter lighting. When pupil size changes, pigment in the iris compress or spread apart, which can change the eye color.

4) What makes eyes green?

The color of green eyes is not a result of iris pigmentation. Green eyes are due to a combination of amber or light brown pigmentation of the stroma. There is a low or moderate concentration of melanin. The green appearance is due to the Rayleigh scattering of reflected light.

5) What can I do to change my eye color?

Color contact lenses are available if you want to change your eye color. There are even colored contact lenses with patterns for occasions such as Halloween. Since contact lenses are medical devices, visit your doctor of optometry for a contact lens fitting.

~Melissa Barnett, OD, FAAO
California Optometric Association
http://www.coavision.org

Vision therapy to improve academic & athletic performance

Image

Vision therapy (VT) is a high effective type of physical and perceptual therapy that works on improving eye muscle control and coordination, eye-hand and eye-body coordination, as well as visual processing/understanding and visual cognitive skills.

Seeing takes place in the brain instead of the eyes. The eyes are the instruments which transmit visual images to the brain. The brain then processes and integrates visual information with other systems such as the vestibular system to affect balance and spatial localization, as well as affecting understanding of what is seen or read. VT uses neuroplasticity to improve visual functioning and the activities that require vision.

When most people think of good vision, they think of seeing clearly– that is, having 20/20 vision. While seeing clearly is important, it is only one aspect of vision.

Having good vision involves much more than seeing 20/20. Being a good reader, a good driver, or a good athlete requires mastering a complex set of vision skills, such as eye tracking, eye teaming, visual perception and visual memory. Unfortunately, many children and adults have problems with these types of visual skills. Although they may see 20/20, they do not have good vision. They may have trouble reading or working on a computer. They may have difficulty driving or excelling in sports.

It is estimated that as many as 20 percent of people may suffer from these types of problems. Please click here to see if you may have a treatable vision problem that is interfering with your work, reading or sports performance.

Vision therapy can treat many problems including:

  • Strabismus
  • Amblyopia
  • Visually-related learning problems
  • Visual Impairment after Brain Injury (such as stroke, craniotomy)
  • Double vision
  • Sports Vision – to enhance athletic performance through faster and more accurate visual motor skills
  • Computer Vision Syndrome (headaches, eyestrain, decreased productivity)

Here are the most frequently asked questions about VT:

1. How do I know that I may need VT?

A: There are many symptoms that indicate a need for VT. Some of the more common symptoms are: eyestrain associated with reading or computer use, not performing to potential at school or work, poor eye-hand coordination with sports or handwriting, double vision, print that appears to “move” on the page, and losing your place while reading.

Special tests will determine if your specific vision problems can be treated with VT.

If you have two or more of the following symptoms, you can benefit from VT. It takes energy to compensate for a vision problem, which results in discomfort and loss of productivity. Improving your visual skills can improve your academic, athletic and executive performance.

  • My eyes feel tired or uncomfortable while reading
  • Headaches while reading or studying
  • Reading or computer use makes me sleepy
  • I, or my child, is not performing to my potential in school or work
  • I have difficulty remembering what I have read
  • Frequent loss of concentration while reading
  • Words move, jump, or appear to “swim”
  • Double vision
  • I am a slow reader
  • “Pulling” sensation around eyes while reading
  • Words blur, or go in and out of focus
  • I often lose my place, or jump over letters & words
  • I often re-read the same line over and over
  • I do not like to read for pleasure
  • I have a short attention span while reading compared to other activities
  • I have poor eye-hand coordination while playing sports
  • I have poor depth perception
  • I learn better visually than verbally
  •  I get dizzy reading in the car
  • I have difficulty judging distances such as parallel parking or stopping a car
  • I have difficulty making visual judgments such as the depth of stairs, pouring coffee into a cup

2. What is involved with vision therapy?

A: A vision therapy program incorporates many different exercises that train deficient visual skills. Learning visual skills is like learning to play the piano, or a new sport. VT exercises are performed in our office under the supervision of a vision therapist. We also prescribe home therapy to reinforce and accelerate the development of newly learned skills.

The length of the VT program depends on the nature and severity of your vision problem.

3. What results can I expect?

A: You can expect your vision to improve significantly or completely if you stick to the program as prescribed by the doctor. The amount of your improvement depends on the type of vision problem(s) you have, how well you follow doctor’s orders and how regularly you practice your vision exercises.

4. Will my insurance cover vision therapy?

A: Few insurance plans cover VT, but it depends on your particular insurance coverage. The California Optometric Association has several doctors who specialize in vision therapy who would be happy to help you determine if you have any allowance for vision therapy.

5. What kind of vision problems can be treated with vision therapy?

VT can treat a variety of vision problems including:

  • Strabismus (eye turn)
  • Amblyopia (lazy eye)
  • Oculomotor dysfunction
  • Focusing problems
  • Double vision
  • Convergence insufficiency or excess

Visually-related learning problems

Visual motor or visual perceptual problems can interfere with the input and processing of visual information. This decreases a student’s performance on reading and writing tasks, which are highly dependent on visual skills (see symptom checklist below).

Visual motor problems can occur in these skills: tracking, eye teaming, or focusing.

Visual perceptual delays can occur in: visual-motor integration, visual memory or sequential memory, visual discrimination, visual figure ground, visual form constancy, or speed of visual processing.

Sports performance enhancement therapy

Image

Photo courtesy of DeusXFlorida on Flickr.com

VT can be used to improve athletic performance through increasing visual accuracy, speed of visual reaction time, depth perception, tracking speed (to follow a target quickly), increasing the span of recognition, and improving eye-hand and eye-body coordination.

Enhancing Executive Performance

VT can be used to improve work productivity by increasing visual stamina, decreasing symptoms such as eyestrain or headaches associated with desk or computer work, improving speed of scanning and reading.

Visual Rehabilitation after Brain Injury

80 percent of the brain is related to visual function; therefore, after an injury to the brain (such as stroke, craniotomy, aneurysm or trauma) visual skills and activities dependent on visual skills (such as walking and driving) are often impaired. VT can be used to train the non-damaged part of the brain to do what the damaged part used to do.

Symptoms of brain injury-related visual impairment include double vision, poor judgment of distance while driving or reaching for objects, hemianopsia or loss of side vision, frequent loss of place while reading, skipping words, sensitivity to light, vertigo, fluctuating vision, bumping into objects, decreased depth perception, leaning to one side, and eyestrain.

Please refer to the section on Brain Injuries for more information.

6. Can Adults benefit from VT?

A: Vision therapy benefits adults. In fact, Dr. Brisco went through VT as an adult, and it has tremendously contributed to her improved reading speed and comprehension, as well as her tennis game!

Vision problems that were not corrected during childhood often persist through adulthood, thus interfering with efficiency and productivity on visual tasks. The majority of vision problems are treatable at any age, but it is better to catch problems early to maximize your potential during your academic and executive career.

~By Elise Brisco, OD, FCOVD, FAAO