Most people would probably admit that childhood is an awkward time. It’s a time of learning and growth — both mentally and physically. We likely all had that aunt, uncle, grandma or grandpa who assured us that we’d grow into our nose or ears or grow out of our acne or lisp. As a child, in our impatience, it may have seemed that the time may never come. And it’s even far more concerning, and detrimental, when it seems that those supposed childhood afflictions don’t resolve themselves and instead appear to follow us into adulthood.
One such visual condition typically diagnosed and treated in childhood is strabismus. Strabismus is, at its most basic definition, a misalignment of the eyes. “Eyes may drift inward or outward or may be vertically misaligned,” said Shepherd Eye Center pediatric ophthalmologist and strabismus expert Dr. Adam Rovit. “What is often discussed as a childhood problem is something that can afflict adults as well. Adult strabismus may be the residual effect of the condition left untreated from childhood, but there are also many reasons that someone may acquire the condition in adulthood,” Rovit said. Strabismus may be caused by thyroid issues, stroke, or persistent diabetes, for example, but many times may have no identifiable cause. The good news, in most cases it is treatable.
For many decades, it was the assumption that any strabismus left untreated during childhood was impossible to treat in adulthood.
“While for amblyopia, or lazy eye, it is true that treatment becomes difficult past a certain age, the same is not true for strabismus. This knowledge that something can be done for misaligned eyes is a true revelation for patients dealing with this problem,” said Rovit.
A second myth surrounding strabismus is that this misalignment is only cosmetic, therefore, unnecessary to treat. “Unfortunately, the idea that strabismus is merely cosmetic is untrue,” said Rovit. “There is only one correct position for eyes, and it is straight. There are no variations.” Treatment of strabismus can improve peripheral vision and diplopia (double vision), if it accompanies the strabismus. Treatment may also improve depth perception. Because this condition is not merely cosmetic, chances are good that insurance will cover treatment.
“A third myth we hear from other medical professionals is that if a patient does not mention the strabismus in an exam or appointment, it must not be bothering them,” said Rovit. “I assure you it does bother them, and does warrant a further conversation, especially now as we try to educate both doctors and patients that there are procedures and surgeries available to treat the condition.” “There is definitely the potential for the condition to affect a person’s business and social interactions as well as his or her self-esteem.”
Treatment of strabismus begins with a comprehensive eye exam, possibly blood work (to test for diseases that may be causing adult-onset strabismus,) and when necessary, neuro imaging to get a better picture of the eyes. Treatment such as glasses or glasses with prisms may be recommended. “Essentially prisms in eyeglasses bend the light coming into the eye so a similar spot on both retinas is viewing the same object in each eye and the brain can straighten the eyes and pull together the two images into one,” said Rovit. “While prisms are good for treating small amounts of crossing and drifting, more significant amounts of misalignment are hard to treat with prism glasses because the lens either becomes too thick to be comfortable, or the quality of the image seen is compromised,” Rovit said.
When prism glasses aren’t enough to correct the issue, surgery on the eye muscles can help to correct strabismus. “I have many patients that come to me and tell me that they never knew treatments existed for their strabismus. Either their primary care physicians didn’t know such interventions existed, or they thought that since the patient didn’t bring it up to them it wasn’t anything they were concerned about.”
Rovit encourages anyone who is experiencing misalignment or persistent double vision to seek medical attention. An ophthalmologist will be able to tell you if the symptoms are coming from some more serious cause, or not, and will be able to recommend the most appropriate course of action for treating the strabismus.