06/05/2025
𝗧𝘄𝗼 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝘄𝗶𝘁𝗵 𝗲𝘅𝗼𝘁𝗿𝗼𝗽𝗶𝗮. 𝗧𝘄𝗼 𝘃𝗲𝗿𝘆 𝗱𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝘁 𝗷𝗼𝘂𝗿𝗻𝗲𝘆𝘀.
One is a 7.5-year-old boy referred to me last November. His intermittent exotropia was worsening and had become manifest most of the time. One ophthalmologist recommended surgery. Another suggested “eye exercises.”
My initial (pertinent) findings:
👉 Unaided RE 6/9 LE 6/9
👉 Refraction RE +0.50 LE +0.50
👉 Distance: 20^ intermittent left XT
👉 Near: 20^ XOP
👉 Fusional reserves at near: BO break 25^, recovery 1^ 😒
👉 BI Break 18^ recovery 9^
👉 Distance: BO break: 8^, recovery 1^ 😒
👉 RDS: 20"
Yesterday, after 18 weeks of therapy (with 2 to go):
👉 Distance: 15^ XOP
👉 Near: 6^ XOP
👉 Near BO: break 40^, recovery 35^ 😊
👉 Distance BO: break 25^, recovery 20^ 😊
Earlier in the day, I saw a 32-year-old woman referred by her orthoptist. In her class photo at age 6, her exotropia is already visible. It was intermittent, monitored for years. At 22, she elected surgery. Three days post-op, the deviation returned. Yesterday, I measured DV 30^ intermittent alternating (mostly left) XT and NV 25^ intermittent XT.
She’s sensitive, so no video. But I’ve gave her a guarded prognosis.
I don’t know how things might have turned out had I seen her earlier pre-surgery (2015). But over 35 years, I've certainly seen how a collaborative approach—ophthalmology and developmental optometry working together— have provided better outcomes.
And I’m not the only one. There’s a timely article in press:
𝗗𝗲𝗹 𝗖𝗮𝗺𝗽𝗼 & 𝗟𝗲𝗻𝗮𝗿𝘁 (𝟮𝟬𝟮𝟱)– 𝘊𝘰𝘭𝘭𝘢𝘣𝘰𝘳𝘢𝘵𝘪𝘷𝘦 𝘔𝘢𝘯𝘢𝘨𝘦𝘮𝘦𝘯𝘵 𝘰𝘧 𝘚𝘵𝘳𝘢𝘣𝘪𝘴𝘮𝘶𝘴 𝘪𝘯 𝘈𝘥𝘷𝘢𝘯𝘤𝘦𝘴 𝘪𝘯 𝘖𝘱𝘩𝘵𝘩𝘢𝘭𝘮𝘰𝘭𝘰𝘨𝘺 𝘢𝘯𝘥 𝘖𝘱𝘵𝘰𝘮𝘦𝘵𝘳𝘺.
Here's a snippet:
𝗙𝘂𝘁𝘂𝗿𝗲 𝗗𝗶𝗿𝗲𝗰𝘁𝗶𝗼𝗻𝘀
𝘌𝘧𝘧𝘦𝘤𝘵𝘪𝘷𝘦 𝘤𝘰𝘮𝘮𝘶𝘯𝘪𝘤𝘢𝘵𝘪𝘰𝘯 𝘣𝘦𝘵𝘸𝘦𝘦𝘯 𝘵𝘩𝘦 𝘵𝘳𝘦𝘢𝘵𝘪𝘯𝘨 𝘰𝘱𝘵𝘰𝘮𝘦𝘵𝘳𝘪𝘴𝘵, 𝘰𝘱𝘩𝘵𝘩𝘢𝘭𝘮𝘰𝘭𝘰𝘨𝘪𝘴𝘵, 𝘢𝘯𝘥 𝘵𝘩𝘦 𝘱𝘢𝘵𝘪𝘦𝘯𝘵 𝘢𝘯𝘥 𝘧𝘢𝘮𝘪𝘭𝘺 𝘪𝘴 𝘢 𝘤𝘳𝘪𝘵𝘪𝘤𝘢𝘭 𝘧𝘢𝘤𝘵𝘰𝘳 𝘪𝘯 𝘰𝘱𝘵𝘪𝘮𝘪𝘻𝘪𝘯𝘨 𝘵𝘳𝘦𝘢𝘵𝘮𝘦𝘯𝘵 𝘰𝘶𝘵𝘤𝘰𝘮𝘦𝘴 𝘧𝘰𝘳 𝘴𝘵𝘳𝘢𝘣𝘪𝘴𝘮𝘶𝘴. 𝘈 𝘤𝘰𝘮𝘱𝘳𝘦𝘩𝘦𝘯𝘴𝘪𝘷𝘦 𝘵𝘳𝘦𝘢𝘵𝘮𝘦𝘯𝘵 𝘱𝘭𝘢𝘯 𝘳𝘦𝘲𝘶𝘪𝘳𝘦𝘴 𝘤𝘰𝘭𝘭𝘢𝘣𝘰𝘳𝘢𝘵𝘪𝘰𝘯 𝘣𝘦𝘵𝘸𝘦𝘦𝘯 𝘵𝘩𝘦 𝘱𝘦𝘥𝘪𝘢𝘵𝘳𝘪𝘤 𝘰𝘱𝘩𝘵𝘩𝘢𝘭𝘮𝘰𝘭𝘰𝘨𝘪𝘴𝘵 𝘢𝘯𝘥 𝘥𝘦𝘷𝘦𝘭𝘰𝘱𝘮𝘦𝘯𝘵𝘢𝘭 𝘰𝘱𝘵𝘰𝘮𝘦𝘵𝘳𝘪𝘴𝘵, 𝘭𝘦𝘷𝘦𝘳𝘢𝘨𝘪𝘯𝘨 𝘵𝘩𝘦𝘪𝘳 𝘤𝘰𝘮𝘣𝘪𝘯𝘦𝘥 𝘦𝘹𝘱𝘦𝘳𝘵𝘪𝘴𝘦. 𝘏𝘪𝘴𝘵𝘰𝘳𝘪𝘤𝘢𝘭𝘭𝘺, 𝘵𝘩𝘪𝘴 𝘮𝘶𝘭𝘵𝘪𝘥𝘪𝘴𝘤𝘪𝘱𝘭𝘪𝘯𝘢𝘳𝘺 𝘢𝘱𝘱𝘳𝘰𝘢𝘤𝘩 𝘩𝘢𝘴 𝘣𝘦𝘦𝘯 𝘭𝘢𝘤𝘬𝘪𝘯𝘨; 𝘺𝘦𝘵, 𝘪𝘵 𝘪𝘴 𝘦𝘴𝘴𝘦𝘯𝘵𝘪𝘢𝘭 𝘧𝘰𝘳 𝘢𝘤𝘩𝘪𝘦𝘷𝘪𝘯𝘨 𝘰𝘱𝘵𝘪𝘮𝘢𝘭 𝘳𝘦𝘴𝘶𝘭𝘵𝘴...
It’s days like these that remind me how meaningful our work can be. What a privilege!! I actually find it quite addictive.
𝗢𝗽𝘁𝗼𝗺𝗲𝘁𝗿𝘆: 𝗜𝘁 𝗰𝗮𝗻 𝗯𝗲 𝗮𝗺𝗮𝘇𝗶𝗻𝗴!
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𝗧𝘄𝗼 𝗽𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝘄𝗶𝘁𝗵 𝗲𝘅𝗼𝘁𝗿𝗼𝗽𝗶𝗮. 𝗧𝘄𝗼 𝘃𝗲𝗿𝘆 𝗱𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝘁 𝗷𝗼𝘂𝗿𝗻𝗲𝘆𝘀. One is a 7.5-year-old boy referred to me last November. His intermittent exotropia was worsening a...
