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Accommodative Esotropia

Excessive inward turning of one eye which is due to poor sensory integration of the focusing (accommodative) system and the eye teaming and alignment system of the two eyes (binocular vision).

Treatment of Accommodative Esotropia includes the use of corrective prescription lenses to align the eyes and often the eyes will spontaneously begin to work together (binocular vision and eye teaming). In other cases, eye patching and/or Vision Therapy will be necessary.

According to our expert eye doctors, Accommodative Esotropia should NEVER be treated with strabismus surgery as this can cause focusing problems when the patient gets older.

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Amblyopia is the medical term for impaired vision in one eye that can not be corrected to 20/20 with the application of a prescription lens. This vision deficit occurs in the brain, not in the eyeball.

Current 21st century scientific research has established that the human brain can change at any age (neuroplasticity) and, also, that amblyopia can be successfully treated in older children and adults. Nevertheless, most eye doctors who practice today went to medical or optometry college before these new scientific discoveries were made and they continue to follow outdated theories regarding cut-off ages for the treatment of amblyopia. In other words, most eye doctors still maintain that amblyopia can not be successfully treated after a certain young age.

The eye doctors in this directory keep abreast of the latest vision and brain research and provide effective treatment programs for patients with amblyopia.

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Binocular Vision

Binocular Vision (bi-n-ocular) is two-eyed vision. In normal human binocular vision, two eyes -- side-by-side in the front of the head -- send two separate images to the brain. These two separate inputs are then fused together IN THE BRAIN to make one unified 3D stereo image. The successful fusion of two eye views into one 3D image is also called 3D stereo vision or stereoscopic vision.

3D Stereo Vision -- which happens in the brain -- gives the viewer greater, more accurate perception of detail, color, volume, location, and depth (3D depth perception). With 3D depth perception, a person has a much keener sense of where he or she is in space in relation to others in the environment, especially in relationship to moving objects (spacial relationships).

Lack of binocular vision, therefore, can negatively impact 3D depth perception, sports coordination, driving safety, spacial judgement and memory, as well as organizational skills, and more.

In all types of strabismus, binocular vision is disrupted and loss of this visual/perceptual ability can contribute to spacial misjudgement and confusion.

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Convergence Insufficiency

A relatively common -- and also commonly undetected -- near vision disorder that makes seeing at close distances laborious and faulty. The two eyes struggle to maintain the inward eye teaming coordination and focus (convergence) that are required for successful reading, desk work, arts and crafts, and close viewing.

Convergence Insufficiency and Reading Problems

Studies show that children with convergence insufficiency demonstrate the following symptoms specifically during reading and close viewing: losing their place or focus frequently, rereading the same line over and over, struggling with concentration or comprehension, growing drowsy, complaining of headaches, double vision, or eye strain. If a person shows these symptoms only during reading or close work, testing for convergence insufficiency or other eye teaming and eye tracking problems is recommended.

Convergence Insufficiency and Hand-Eye Coordination

People with convergence insufficiency often have problems with hand-eye coordination when near vision and depth perception are needed. They can tend to knock things over, bump into objects, have difficulties catching a ball or be accident-prone with hand tools or other hand-eye coordination tasks.

Convergence Insufficiency and Intermittent Exotropia

The stress of convergence insufficiency can cause an intermittent exotropia (occasional outward eye turn). This form of strabismus can resolve when the convergence insufficiency is successfully treated with Vision Therapy.

Treatment of Convergence Insufficiency

Convergence Insufficency -- a NEUROLOGICALLY ACTIVE visual condition -- involves problems with brain-eye-body coordination and the insufficiency can not be isolated and/or "fixed" in separation from the person's brain and nervous system. In other words, it needs to be emphasized that it is the person's neurological signals and the "instructions" to the eye muscles that are insufficient. It is not the eye muscles that are insufficient. There is no physical defect in the eye muscles. Eye muscle surgery (which is NOT brain surgery) is not going to change the brain's signals and instructions to the eyes. It is widely accepted that eye muscle surgery is NOT advised for convergence insufficiency.

Vision Therapy for Convergence Insufficiency

A multi-year, multi-site NIH National Eye Institute study proved that in-office vision therapy is the most effective treatment for convergence insufficiency. The long-standing standard practice of prescribing pencil push-ups only has been proven to be ineffective.

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Estropia is the general term for the type of strabismus with an inward eye turn(s) or when one or both eye(s) deviate toward the nose. The inward eye deviation can be occasional (intermittent) or constant.

Esotropia is more common in infants and young children than exotropia. Treatment depends on age of onset, severity, and many factors.

The pediatric eye doctors listed here in our FIND A DOCTOR locator offer the full range of treatment options, including non-surgical therapies. Pediatric ophthalmologists are surgeons and generally do not offer non-surgical therapies.

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Exotropia is the medical term for the type of strabismus in which the person as an outward eye turn(s). The same eye may deviate outward or both eyes can alternate in their outward deviation. The outward eye deviation can be noticeable occasionally (intermittently) or constantly.

The developmental optometrists listed here in our FIND A DOCTOR locator offer the full range of treatment options for esotropia, including non-surgical therapies. Pediatric ophthalmologists are surgeons and generally offer pharmaceuticals and surgery only as treatment options.

Eye Teaming
All types of strabismus can adversely affect eye teaming ability.

In normal healthy vision, the two eyes work and move together simultaneously as a coordinated team for single 3D stereo vision and two-eyed depth perception (with no double vision!). Eye teaming is an neurologically active process…the brain signals the eye muscles in order to coordinate eye movements and visual processing.

Eye patching does not help eye teaming problems because one eye is covered in patch therapy and, therefore, the coordination of the two eyes as a team is not being stimulated or reinforced. Healthy eye teaming with depth perception can be developed or retrained at any age with non-surgical Vision Therapy.

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Intermittent Exotropia

An outward eye turn that is occasional or alternating and might only occur when the person is ill, tired, anxious, stressed, etc.

Intermittent Exotropia is a type of strabismus, but in some cases it is a symptom of another common near vision condition called convergence insufficiency.

Intermittent Exotropia responds best to non-surgical Vision Therapy treatment. Strabismus eye muscle surgery is not recommended.

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What is Strabismus Surgery?

Strabismus Surgery is a surgical treatment in which the eye muscles that steer and aim the eyeballs are cut, adjusted and reattached. The surgery is performed on the eye muscles only…other parts of the visual system, eye or brain are not touched.

Our panel of expert eye doctors points out that we see with our brains, not our eyeballs. In other words, it is the brain and nervous system that signals and instructs the actions of the eye muscles. Therefore, strabismus surgery -- which is not brain surgery or brain training -- does not address the root cause of strabismus.

Co-Management of Strabismus Surgery

NOTE: surgery of any type should be co-managed between a primary care doctor and a surgeon. Co-management by a primary care doctor is recommended because the surgeon typically provides minimal or no pre- and post- surgical consultation or care. The surgeon simply performs the surgery.

Strabismus Surgery, when appropriate for a given condition, is more effective when primary care optometric co-management and Vision Therapy are part of the treatment plan.

The primary eye care optometrists in this directory provide the pre- and post- surgical co-management and care that is in the best interests of the patient.

Is Once Enough? Multiple Strabismus Surgeries?

Multiple surgeries on the same eye are often performed by eye surgeons when eye muscle surgery alone does not resolve the strabismus and the eye turn reappears.

What is Lazy Eye Surgery?

Strabismus surgery is also sometimes commonly referred to as lazy eye surgery, however, this is confusing. Lazy eye is actually the popular term for the medical condition called Amblyopia and Amblyopia and Strabismus are not the same visual condition.

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Lazy Eye

Lazy Eye is the popular term for Amblyopia, but the general public often also uses this phrase to refer to all types of Strabismus as well. In other words, sometimes when a layman sees an eye turn, he or she might say, "lazy eye."

This is confusing because Strabismus and Amblyopia (lazy eye) are NOT the same medical and visual condition. Yes, Strabismus can sometimes cause Amblyopia, but they are still not the same condition and need different treatment plans.

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Depth Perception

Two eyes working together as a coordinated team, aiming at the same focal point with simultaneous timing, gives the viewer the added visual perception of the depth dimension. With 3D Depth perception, the viewer visually perceives three spatial dimensions of width, height, AND depth (x, y, and z).

3D Depth Perception also gives the viewer more accurate perception of detail, volume, solidity, color, spacial relationships, and location. Good depth perception makes hand-eye coordination much easier.

Depth Perception and Strabismus

Strabismus, a binocular vision disorder, often leads to diminished or little depth perception.

Depth Perception Treatment and Improvement

Depth perception can be developed, recovered and/or enhanced with non-surgical Vision Therapy and/or prism lenses.

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Double Vision

If the two eyes do not aim at exactly the same visual target, two mismatching images are sent to the brain. Double Vision occurs when the brain can not fuse the two mismatching images into one unified 3D image AND, at the same time, does not suppress (block out) one of the mismatching images. The doubling effect means that the visual system (eyes, brain and body) is missing out on stereo fusion (stereoscopic vision) and 3D depth perception.

Double vision occurs in the brain, so eye muscle surgery (which is NOT brain surgery!) is not appropriate or successful treatment. There is no brain surgery that helps double vision either, because single 3D vision is created by the coordinated effort of many regions of the brain. Vision therapy trains and/or rehabilitates the brain and is, therefore, the effective way to turn double vision into single 3D vision.

Double vision can be a symptom of binocular vision disorders, such as Strabismus or a related condition called Convergence Insufficiency.

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Duane's Syndrome

Duane's Syndrome is a type of Strabismus which demonstrates various symptoms: inability to move an eye laterally away from the nose (palpebral fissure), retraction of the eye with close viewing or when one looks toward the nose; and inward eye turn with distance viewing. It can be confused with paralysis of an eye muscle (lateral rectus) and that can lead to a referral for an unnecessary neurological evaluation.

Surgery should not be performed unless there is a cosmetic problem when looking straight ahead and the patient desires cosmetic benefits only. The eye muscle surgery will not change the brain and improve vision. In some case, a better solution can be prescription prism eyeglasses. Some patients with Duane's Syndrome have secondary eye convergence problems which are effectively helped by Vision Therapy.

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The facial characteristics of infants and young toddlers can sometimes create the appearance of an inward eye turn or crossed eye when, actually, the two eyes are aligned and healthy. Nevertheless, it is recommended that all children receive their first complete eye examination at six months of age to rule out amblyopia or other eye disorders. Pediatricians are not trained to give adequate or complete eye/vision examinations.

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Vision Therapy

Described as physical therapy for the visual system (brain, eyes, body), Vision Therapy is effective non-surgical therapy or neurological training for many visual conditions, including most types of Strabismus and their related conditions, such as Lazy Eye, Convergence Insufficiency, Eye Tracking and Eye Teaming problems, Esophoria, Exophoria, etc.

FIND AN EYE DOCTOR - Strabismus and Amblyopia (Lazy Eye) Treatments

Welcome! Find a licensed Eye Doctor who specializes in Strabismus and Amblyopia Treatments, including Pediatrics, Primary Care Co-Management of Lazy Eye and Strabismus Surgery, Board Certified Non-surgical Vision Therapy, Prism Lenses, etc.

These Doctors of Optometry are experienced in the successful treatment of all types of Strabismus and Amblyopia and their related conditions, such as Convergence Insufficiency, Esotropia (Cross Eyed), Esophoria, Exotropia, Depth Perception Problems, Diplopia (Double Vision), Duane's Syndrome, Intermittent Exotropia, etc.

Note: FCOVD denotes Board Certification in Children's Visual Development and Optometric Vision Therapy (FCOVD).

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Requesting referral for:


This person has symptoms of or has already been diagnosed with (check one or more):

Accommodative Esotropia
Amblyopia (Lazy Eye)
A.D.D. or AD/HD
Autism Spectrum Disorder
Brown's Syndrome
Congenital Esotropia
Convergence Insufficiency
Poor Depth perception
Developmental Delays
Double Vision (diplopia)
Duane's Syndrome
Esotropia (inward eye turn)
Exotropia (outward eye turn)
Eye teaming problems
Eye tracking problems
Hyperopia (farsightedness)
Hyperphoria (vertical)
Hypertropia (vertical)
Myopia (nearsightedness)
Poor depth perception
Retinal Detachment

Has this person previously had lazy eye or strabismus surgery? No Yes    
If Yes: Did the strabismus surgery have to be repeated? No Yes
How many eye muscle surgeries total has this person had for strabismus or amblyopia (lazy eye)?
If Yes, did eye muscle surgery yield cosmetic benefits only for the patient?
If Yes, did the strabismus surgery result in improved vision for the patient?
Is this person currently under the care of an eye doctor? No Yes
Has this eye care provider informed you or the patient about all available Strabismus treatments, including non-surgical Vision Therapy? No Yes
Do not know

Additional comments on symptoms, treatments, medical history:

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