Wow Vision Therapy Blog

Strabismus is relatively common, affecting approximately 2–4% of the population. It is often described as an “eye muscle problem,” but that doesn’t tell the whole story.

Our six extraocular muscles move each eye. But those muscles don’t decide where the eyes should point, what they should follow, or how the two eyes coordinate.

The brain does.

Normal binocular vision requires the brain to accurately direct both eyes toward the same target, coordinate their movements, and combine two images into one three-dimensional perception of the world.

When this system doesn’t develop normally, the brain may suppress one eye to avoid double vision. Binocular fusion and stereopsis—true binocular depth perception—may be reduced or absent.

Strabismus is not simply about where the eyes point. It involves how the brain has learned to use the two eyes together.

Moving the Eyes and Teaching the Brain Are Two Different Things

Strabismus surgery changes the mechanical forces acting upon the eyes. For the right patient, particularly someone with a large-angle deviation, surgery can be extremely valuable in creating better alignment.

But there is another part of the equation:

The brain still has to learn how to use the eyes together.

Much like rehabilitation following an orthopedic procedure, improved mechanics can create an opportunity for better function—but the nervous system must learn how to use that opportunity.

That is where office-based optometric vision therapy can play an essential role.

Our Goal Goes Beyond Two Eyes That Look Straight

At Wow Vision Therapy, our goal is functional binocular vision.

Depending upon the individual, treatment may address suppression, sensory and motor fusion, stereopsis, binocular stability, eye movement control, accommodation and vergence, visual processing, and visual-motor integration.

In other words, we aren’t simply asking:

“Are the eyes straight?”

We are asking:

“What can this person DO with two eyes working together?”

That is a very different measure of success.

Vision Therapy, Surgery—or Both?

This does not need to be a choice between vision therapy and strabismus surgery. They can address different parts of a complex binocular condition.

Many patients can make substantial gains through office-based vision therapy without surgery. For others, particularly with larger-angle deviations, surgery can be an important part of treatment.

For those patients, we collaborate with ophthalmologists and strabismus surgeons.

Vision therapy before surgery can help develop binocular awareness, reduce suppression, and improve the patient’s ability to use both eyes. Surgery can improve mechanical alignment, while post-surgical vision therapy can help the brain learn to coordinate and use the eyes within that improved alignment.

The better question may therefore be:

“What combination of treatment gives this patient the best opportunity to develop stable, functional binocular vision?”

What About Adults Who Were Told, “You’re Too Old”?

We meet adults who have lived with strabismus since childhood and were told years ago that nothing more could be done.

But our understanding of neuroplasticity tells us that the nervous system retains a capacity for change throughout life.

Age influences development and treatment, and no treatment can guarantee normal stereopsis. But age alone should not automatically determine someone’s potential for improvement.

For some adults, developing binocular awareness and depth perception after decades without it can be remarkable—suddenly noticing the dimensionality of trees, the space between objects, the contours of a face, or simply experiencing the world with a sense of depth they had never known before.

A Better Definition of Success

Successful strabismus treatment should be about more than eye alignment.

Our goal is to help each patient achieve the highest level of binocular visual function their visual system is capable of developing.

That may involve vision therapy alone. It may involve vision therapy combined with surgery. And it may involve treating a young child—or evaluating an adult who was told decades ago that it was “too late.”

Because straight eyes are important.

But straight eyes that the brain can actually use together?

That’s an entirely different goal.

At Wow Vision Therapy, our doctors provide comprehensive developmental and binocular vision evaluations for children, teenagers, and adults with strabismus. We also collaborate with ophthalmologists and strabismus surgeons when surgical alignment is an appropriate component of treatment.

Our goal is to help each patient develop the best binocular vision—and the best quality of life—they are capable of achieving.

If you or your child has strabismus,  contact our office to learn more and schedule a comprehensive Functional Binocular Vision Evaluation.

Dan L. Fortenbacher, O.D., FOVDR
Founder, Wow Vision Therapy