Role of optometric vision therapy for surgically treated strabismus patients.

BACKGROUND: Occasionally, co-management involving both optometry and ophthalmology is needed to optimize treatment outcome for the strabismic patient. METHODS: JB, a 47-month-old consecutive esotrope presented to our clinic. Two previous attempts to surgically correct her exotropia had failed and the parents sought another treatment approach. We recommended optometric vision therapy (VT) to improve sensorimotor fusion before any further surgery. After 31 VT sessions (bi-weekly for a time, then weekly), before a third scheduled surgery, sensorimotor fusion was good in the amblyoscope, but unstable with neutralizing prism in free-space. We recommended surgery be postponed, but the family proceeded. Esotropia recurred with constant suppression. After additional VT, JB developed stable sensorimotor fusion and random dot stereopsis in free-space with neutralizing prism. A fourth surgery was then performed resulting in esophoria at all distances with good sensory fusion. RESULTS: Twenty-one months postoperatively, JB remains nonstrabismic with good sensory fusion. CONCLUSIONS: Clinicians should understand the roles and limitations of available treatment options. Surgery reduces the magnitude of the deviation, whereas optometric VT provides the unique role of establishing normal sensory processing.

Method for estimating the spheric aberration of the human crystalline lens in vivo.

PURPOSE: The authors describe a method for estimating the spheric aberration (SA) of the human crystalline lens in vivo. METHODS: This method was based on a comparison of the measured change in contrast sensitivity (delta log (CSF)) of the eye and the calculated change in modulation transfer function of the cornea with undilated and dilated pupils. The method assumes that the total change in visual efficiency (delta log (CSF)) in these two states is caused entirely by the SA of the eye combined with the Stiles-Crawford effect. RESULTS: Data are reported for 20 subjects (age range, 20-56 yr). SA for the whole eye was found to be positive and in the range 0-0.83 D (0-0.80 D using Stiles-Crawford apodization). The SA of the crystalline lens was generally negative and in the range 0 to -0.81 D (0 to -0.78 D using apodization). CONCLUSIONS: The method gives results consistent with previous reports in the literature. Despite potential limitations, the technique offers a new method for estimating the SA of the human crystalline lens in vivo.