Strabismus surgery rates in decline because of non-surgical treatment approaches

We came across this article that reports on a study that was published in a recent issue of the British Journal of Ophthalmology that looked at strabismus surgery rates in children up to the age of 15 from 1963 to 2010 (519,089 children in total).  The study found the rate of strabismus surgery in the United Kingdom had dropped from 189 per 100,000 in 1968 to 64 per 100,000 in 2010, a threefold decrease.

According to the article, the major reason was non-surgical treatment approaches:

A switch from surgical to non-surgical treatment approaches, rather than a genuine fall in the prevalence of strabismus was likely to explain a large part of the decline in procedure rates, said the author, who suggested regional variations may reflect differences in strabismus prevalence.

We have not had a chance to read the study, but we have written extensively on this blog about non-surgical alternatives to strabismus surgery:

Non-surgical treatment alternatives to strabismus surgery - the risk of a single childhood exposure to anesthesia 
Jan 23, 2013
The saftey of using anesthesia in surgery on children is questioned by new scientific evidence. Non surgrical alternatives to strabismus (eye muscle) surgery.

Vision therapy or surgery for strabismus (esotropia, exotropia)
Jan 17, 2013
We here at Vision Source Vancouver think that it makes good sense to use effective non-surgical vision therapy to treat strabismus (sometimes called cross eyes, eye turn, esotropia, exotropia). The reason is that strabismus or ...

Alternatives to strabismus surgery - vision therapy is 87% effective
Oct 28, 2012
Vision therapy is a highly effective non-surgical treatment for strabismus that has been validated in numerous studies.

Another risk of strabismus surgery? 
Mar 07, 2012
Strabismus - a condition where the eye abnormally turns in or out due to one or more of the eye muscles malfunctioning - is often treated with surgery in which the properly functioning muscle is cut and re-attached so that it ...

How vision therapy worked where strabismus surgery failed
Nov 14, 2012
How vision therapy worked where strabismus surgery failed - the story of Dr. Susan Barry and her book, Fixing my Gaze.

After three unsuccessful strabismus surgeries, patient says enough
Nov 19, 2012
Repeat strabismus surgeries are common and are a reason parents seek non-surgical alternatives like vision therapy. ... Vision Therapy is an effective alternative to strabismus surgery. Here is a recent comment by a reader ...

Alternatives to strabismus surgery - vision therapy is 87% effective

Under optimal clinical conditions the success rate for vision therapy treatment of strabismus is 87%

Vision therapy/orthoptics has been used to successfully treat the various forms of strabismus for over 100 years. Numerous studies have found it to have a 75% success rate in achieving normal cosmetic alignment of the eyes as well as functional binocular vision.  Under optimal clinical conditions such as those in a private practice optometric clinic where each patients receives individualized, one-on-one care, the success rate can be as high as 87%.

The Ludlam Study on Vision therapy for strabismus

Dr. William Ludlam conducted a landmark study, but not the first such study, of 149 strabismus patients who came for treatment at the Optometric Centre of New York.  Ludlam summarized the results as follows: 

"combining the functional and almost cured groups and adding four patients whose eyes ware straight ... but are listed as 'moderately improved' because of the the technical requirements of the 'cured' categories (2 subnormal ranges of motor fusion, 1 with a 7" N.P.C. rather than the required 4", and 1 with frequent asthenopia, headaches and accomodative spasm), we may state that a total of 113 (76%) of the patients in the sample had binocular vision with straight eyes 95% of the time or more at dismissal from teh regular clinic training sessions. The other 36 patients had residual deviations occurring more often than 5% of the time, and were classified as orthoptic failures. Of these, 8 of the "moderate improvement" group dropped out when quite near the "almost cured" category, i.e. with their eyes straight well over half the time and possessing all of the technical factors necessary for a cure with several moths of additional stabilization work."

Even though the Ludlam study produced outstanding results, Ludlam pointed out that the patients treated at the Optometric Centre were treated in poor clinical conditions. For example, they received group therapy, control and management of each case was relatively poor, and they were treated by different clinicians who had diferent personalities and treatment approaches.  He expected that under the optimal conditions of a private practice optometric office, the results would be even better.  Indeed, subsequent studies shown this to be the case.   Click here to read more about the Ludlam study.

The Hoffman & Allen Study on vision therapy for strabismus

Another significant study addressed Ludlam's expectation that optimal clinical conditions would produce better results.  The study, by Hoffman, Cohen, et al., found that the vision therapy treatment fo strabismus had an 87% success rate in clinical circumstances that were "near optimal" such as those conditions that obtain at a private practice optometric clinic.  The researchers also found that younger patients were easier to treat than older ones and that exotropes (patients whose eye turns outwards towards the wall) were easier to treat than esotropes (patients whose eye turns inwards towards to nose) .  Even so, the vision therapy treatment of esotropes achieved a very impressive success rate of 74.5%.  Moreover, the maximum success rate of 100% was obtained in treating intermittent and periodic eye turns whereas constant eye turns were treated at a still-impressive success rate of 76%.

Case Reports on vision therapy for strabismus

Numerous case reports have been published documenting the treatment of strabismus patients with vision therapy.  The most recent was published in August 2011 in the journal Optometry by Peddle and Steiner who discussed two cases of adults with moderate sized intermittent exotropia (eyes turned outward to the wall). Both patients also had asthenopia (eye fatigue and discomfort), headaches, and/or diplopia (double vision). Twenty to 30 in-office VT sessions were recommended to reduce the magnitude and frequency of the deviation as well as improve their binocularity and decrease their symptoms. After completing VT, both patients became phoric for all distances, had normal vergence ability, and had normal near points of convergence.

The most famous case of vision therapy treatment for strabismus

In an inspirational book called Fixing My Gaze, neuroscientist, Susan Barry, who was born with strabismus and had lived all her life without depth perception as a consequence, meaning that she could not see in three dimensions.  The book was Amazon.com's number 4 science book of 2009.

She had three surgeries to "correct" the eye turn cosmetically but she still could not see properly and the eye was still turned, although less than before. She had lived this way for over 40 years until she met optometrist Dr. Theresa Ruggiero.

Dr. Ruggiero treated Susan with vision therapy and corrected the eye turn and allowed her see in three dimensions for the first time in her life. Can you imaging how her world was transformed? I've heard rumors of a "Fixing My Gaze" movie but have not been able to confirm them.

Doctor Barry has received much attention for her book and her experience with vision therapy.  She has been interviewed for numerous publications and her story was the subject of a feature article in the New Yorker.  

You can visit Susan Barry's website here.  Here are some videos of Susan Barry talking about vision therapy and strabismus:

For a list of studies on vision therapy treatment of strabismus surgery, click here.

To find a doctor near you, visit the website of the College of Optometrists in Vision Development, here.

Related articles:

• The risks and complications of strabismus surgery

• Risks of using anesthesia during surgery in children

• Strabismus treatment and the limits of what surgery can do, the high risk of repeat surgeries and lack of functional binocular vision with surgery