All About Strabismus
by Dr. Jeffrey Cooper & Rachel Cooper (no relation). © 2001-2013
Early Detection and Treatment
Why So Young?
When should my child have the first eye exam?
This is an important health issue. According to both the American Optometric Association and American Ophthalmological Association, all children should have their first examination around 9 months of age. However, if an extreme or constant eye turn is noticed, the baby should be examined before 9 months. If a constant eye turn or significant refractive error is found, the eyes need to be fully evaluated and corrected as early as possible. Read on to find out why.
The development of keen binocular vision with resultant stereopsis is a result of genetics and appropriate development of the binocular system during the early formative years. The ability to see 20/20, focusing ability (accommodation), eye muscle coordination (aiming or alignment) and stereopsis are all developed by 6 months of age in humans. By 9 months of age, the system is in place.
In general, research suggests that the maximum "critical period" in humans is from just after birth to 2 years of age. Any disruption of binocular vision from 6 months to approximately 4 years will result in strabismus and/or amblyopia. Problems with binocular vision are often not detected by the untrained observer. Thus, every infant without an apparent problem should have their first examination between 9 months to one year of age. By all means, do not hesitate to have children with extreme or constant eye turns examined before 6 months.
Young babies are also easy to exam. Age 2 is neurologically late and a difficult time to examine the young toddler. If everything is normal at that 9 months examination, the next examination should be in kindergarten.
How Would the Eye Doctor Examine an Eye Turn?
The most important diagnostic tool is the history as this allows the doctor to know the age of onset, duration of turning, family history of strabismus, and a medical history. The eye doctor will then attempt to rule out amblyopia, uncorrected refractive error, and amount of deviation. The doctor should dilate the eyes to make sure that there is no hidden eye disease causing the strabismus.
Children with strabismus and amblyopia (lazy eye) must be identified and treated at a young age to obtain the best chances of restoring normal visual acuity in the presence of amblyopia and/or constant strabismus. Thus, the first examination should be performed just after the visual system has completed maturation, so treatment can be initiated immediately, if necessary. This is the period of time in which the visual system is most easily modified.
Will my child outgrow strabismus?
Children do not grow out of eye turns. Proper diagnosis and treatment is necessary. Treatment will depend on the condition and individual. Although, intermittent eye turns do not require aggressive treatment, professional evaluation and monitoring is still recommended.
Eyeglasses may be prescribed to eliminate the eye turn and/or eliminate any optical difference between the eyes. The eye doctor might institute patching to stimulate the "lazy" eye, which was suppressed or turned off (when the two eyes are not aligned, the brain is forced to ignore one of the images to prevent double vision).
Infants or young children should be encouraged to do things which involve hand and eye coordination. Movement and hand eye tasks speed the improvement in treatment of amblyopia and strabismus.