September 4, 2020 - EyeClarity Blog
I recently received a question from a mom from the Midwest whose 8 year old daughter was recently diagnosed with strabismus, or crossed eyes. In her question, she asks me about how my approach is different from what the doctors are recommending. The doctors prescribed her daughter some really strong glasses and they also suggested eye muscle surgery, so she wants another opinion.
Strabismus is a condition where when you look at the eyes, one or both eyes appears to be wandering. When the eyes are wandering in it’s called convergence strabismus, and when one or both eyes are wandering out, it’s called divergence strabismus. There is also vertical strabismus, where the eyes separate vertically and one eye is higher while one eye remains lower. So, strabismus can be seen as a condition where the two eyes are not working together. Because the eyes are misaligned, the brain is going to suppress one eye to avoid double vision. It is a very disconcerting, disorienting situation.
Our visual system and our brain are married together. They’re coupled. In fact, in fetal development in the first trimester, the eyes actually grow out of the brain. So every tissue of the eye is really nothing more than an extension of the brain. Thus, strabismus is really a lack of integration in the eyes. In my philosophy, I have found that anything that’s reflected in the eyes can also be found in the brain, meaning if there’s an integration problem in the eyes, the hemispheres of the brain are also likely having difficulty with integration. You might also see lack of coordination or control in the body as a result of poor integration.
Now, I want to talk about why people develop strabismus, especially as children. There are many developmental milestones that we go through in our early lives that actually begin in utero. For example, if the mother is having a high risk pregnancy and is told to stay on bed rest for fear of a miscarriage, the child will have had less experience with movement. Movement is really important for the fetus’ inner ear, vestibular system, and visual system development. When the fetus is floating in that dark amniotic womb, the peripheral vision also starts to activate. So too much bed rest can actually begin to lay the groundwork for the fetus developing a strabismus pattern. Another reason why strabismus can occur is because of complications in the actual birth experience. If there’s a suction vacuum extraction at birth, a forceps delivery, a breech delivery, or a caesarean section – anything that’s out of the ordinary in terms of the newborn coming out of the birth canal – we will see a very strong effect on the cranium of the newborn. At the time, the head is very soft, so disruption can lead to problems with eye muscles and visual fixation, which will cause strabismus to start to surface. The third reason has to do with the bonding period and early motor development that comes with it. Sometimes if there is a sudden illness or death of a parent that’s very traumatic or the parents aren’t ensuring the infant is engaging in movement (such as crawling and tummy time), there can be a lasting effect on the eyes’ ability to fixate and coordinate together because that kind of movement during infancy is a precursor for that bilateral integration.
When parents see their childrens’ eyes wandering, the two approaches most commonly suggested by doctors are to either give the child strong glasses or strabismus surgery. The thought process behind the strong glasses is that they will force the eyes into straightening out aesthetically, but extremely strong prescriptions don’t allow for movement and exploration of the visual system. They actually end up suffocating the visual development and create a lot of distortion in the child’s vision. Additionally, that prescription is calculated based on the eyes’ ability to perform once given eye drops. What that eye drops do is paralyze the ciliary muscles of the lens of the eye, which are the focusing muscles. By paralyzing the focusing muscles the doctor is able to calculate, measure, and give the strongest prescription possible. It’s a very inaccurate way of really assessing an infant or toddler’s visual experience and it doesn’t lead to positive results.
For the second option, strabismus surgery, literature suggests that the success rate is somewhere between 30 and 80 percent. Furthermore, that success rate is determined by whether or not the eyes look straight cosmetically after the surgery, but there’s no thought about how well the eyes are functioning. A cosmetic cure doesn’t translate to a functional cure. The source of learning how to use your two eyes together takes place in the brain, so if you apply physical therapy to the eyes where you include the brain in the equation, then not only are you going to get cosmetic results, but you’re going to more importantly get functional results.
Oftentimes, people will say that they want the strabismus fixed immediately, in which case, surgery is the avenue you may want to take, but you’re going to end up going back for multiple surgeries. And every time you cut the muscle in the eye, you are disrupting and destroying the relationship between the brain and the eyes. What that does behaviorally with a person is causes them to constantly have to question themselves in any visual decision that they’re making. If someone’s initial response in life is always one of questioning themselves, it creates a major confusion in the brain eye connection.
For children with strabismus, I’ve found a two pronged visual therapy approach to be very successful. First you have to assess the child’s vision based on their developmental age and compare that developmental or performance age with their chronological chronological age. This means that based on where that child is developmentally, you must start re-patterning the eyes, brain, and body from that place. The second important thing to consider is that you must include the whole body in the therapy. There is a hierarchy in our motor development and it starts with learning about moving our bodies in a primordial way, which we call the primitive survival reflexes. These are very early infant reflex patterns that create the foundation for us to later on be able to stand up, crawl, skip, hop, jump rope, play ball, and then eventually hold a pencil and copy from the board, write, or read. Working with this hierarchy of motor development and introducing activities at each level that engage both the entire body and the eyes will lead to success at beginning to reduce the strabismus pattern. The strabismus will end up being less prevalent except for when the child is in situations that trigger stress or trauma and/or illness. With continued work, eventually the visual integration becomes so dominant that the strabismus pattern will completely dissolve away. It’s not an overnight process. It takes time and there are many factors involved. One major factor is how committed the parents are to doing the activities consistently. They will have to work with their children anywhere from 15 to 30 minutes every for about six months to see any progress. They can’t force anything. Forcing the child into doing something with their eyes never works. You can encourage, you can invite, and you can support a process of integration and learning, but whenever you try to impose your will or control, children may start resisting.
I’ve had great success with strabismus over the years, not only with children, but with adults as well. There’s some really outdated research that says that after a certain age, if you don’t do the eye surgery, you’re either going to go blind or your eyes are going to get worse, and that is totally ridiculous. It makes no sense for a doctor to say that, because if you actually look at the idea of neurogenesis and neuroplasticity, there is an amazing research study that just came out whereby researchers crushed the optic nerve of an animal. Afterwards, they then began adding something called BDNF, brain derived neuro trophic factor, a protein that helps grow brain cells as its quantity increases. When they crushed the optic nerve and began giving BDNF to the animals afterwards, within a week the optic nerve grew back by 17 percent and within two weeks it actually regenerated 50 percent of the way. We are capable of healing our eyes, regenerating them, and re-learning. With strabismus, it is nothing more than developing the skill set of using both eyes together.
So for this mom, what I would say is seek out a holistic eye doctor who can offer you physical therapy for your children’s eyes, try to get a reduced prescription, and give this process six months. You’re going to find not only will the eyes straighten cosmetically, but they will also straighten from a functional point of view and it’ll have an incredible impact on your child’s life in terms of decision making, focusing, and bettering her understanding of herself and the world. The process is super effective, and I think it’s so much better than surgery.