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Treatment for “lazy eye” is more than cosmetic  

Dr. Baker examines a pediatric ophthalmology patient at Children’s Hospital of Michigan.

We all know there is no truth to the tale: if you cross your eyes, they will stay that way.  However, nearly five percent of adults suffer from misaligned eyes or strabismus. More commonly referred to as a wandering, crossed, or lazy eye, this condition results in eyes that look in different directions. The eyes are unable to focus simultaneously on a single point and thus there is no binocular vision. If this condition has been long-standing (onset prior to age 8 or so), the brain will learn to suppress or turn off one eye to avoid double vision. For a child, this suppression can lead to amblyopia or poor vision in one eye if not treated. If the strabismus develops as an adult following the age of visual maturity, then persistent double vision is a major problem.

Wayne State University’s John Baker, MD, clinical professor of ophthalmology, recently spoke about adult strabismus in his presentation of the second Marshall M. Parks Lecture at the annual meeting of the American Academy of Ophthalmology.

Chief of ophthalmology at Children’s Hospital of Michigan and a faculty member at the Kresge Eye Institute, Dr. Baker is among a cohort of ophthalmologists who are providing evidence that correction of strabismus as an adult offers much more than just a cosmetic advantage to patients. Treatment can improve depth perception and field of vision in addition to enhancing self-esteem, communication skills, driving and a better chance for career advancement.

 “We (ophthalmologists who deal with strabismus) are often told that correcting adult strabismus is only a cosmetic procedure,” Dr. Baker said. “The normal function of the visual system requires that both eyes are aligned so they can look at the same object at the same time.  Our goal is to restore the eyes to this position for normal functioning.”

Treatment generally requires eye muscle surgery, which can be an insurance problem for some adults. Dr. Baker and his colleagues are showing, however, that there are valid functional reasons to correct misalignment in adults as well as children. For the adult with recent onset strabismus, double vision may be an incapacitating problem. However, even if double vision is not present, strabismus sufferers can frequently regain binocular vision. For those patients whose eyes are crossed inward, aligning the eyes can result in an expanded peripheral visual field of up to 30 degrees, said Dr. Baker.

There are also psychosocial factors associated with strabismus. Full awareness of the extent of the problem is very important, said Dr. Baker. It can greatly impair self-image, interfere with communication, limit job advancement and initial hiring, as well as affect personal interactions.  In a recent study of adult strabismus patients, 85 percent reported that they had problems with work, school and sports because of their strabismus. In the same study, 70 percent said it had a negative effect on their self-image. Fifty percent rated their eye alignment problem as moderate or severe and they reported being anxious and depressed.

 “We need to study the psychosocial effect of strabismus correction on these individuals preoperatively and at six and 12 months postoperatively,” Dr. Baker said. “We need to reach comprehensive ophthalmologists, optometrists, and primary care physicians with the information that their adult patients with strabismus can be greatly helped functionally and that correction is far from only cosmetic.”

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