26/04/2022
To Cut or Not To Cut? Weighing Strabismus Surgery Referral ⚖️
Determine when this intervention is truly better than vision therapy—and how to set expectations.
Understanding when to refer for surgery and combining the skills of a good optometric vision therapist will give your patient the best opportunity for cosmetically straight eyes with some level of stereopsis. To facilitate this for the strabismus patient, follow these steps:
1. Measure BCVA of each eye.
2. Evaluate binocularity to determine deviation and if any immediate spectacle compensation will improve the binocular stasis.
3. Evaluate the ocular motor and accommodative systems.
4. Determine if there is any appreciation of diplopia under any condition.
5. Identify level of suppression and fusion.
6. If there is some level of visual motor function that can be improved by VT, eight sessions should be completed. Then re-evaluate the system for possible improvements, such as less suppression, better cosmetic alignment, improved oculomotor function and better accommodative flexibility.
7. If improvements are identified, continue with eight more sessions and re-evaluate.
8. If there is a plateau in improvement and the deviation is still obvious, referral for surgery should be suggested.
9. After surgery, re-evaluation of visual motor skills should be conducted and post-VT activities should be instituted to maintain gains made through surgery.
Keep reading: reviewofoptometry.com/article/to-cut-or-not-to-cut-weighing-strabismus-surgery-referral
