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What is strabismus?
Strabismus is a disorder of the neurological system or an anatomical anomaly which manifest int he misalignment of the eyes. The misalignment can be in any direction and is often referred to as crossed eyed or wall eyed. The strabismus can be constant or noted transiently depending on the time of day, level of fatigue, or activity.
What are the symptoms?
When occurring in a child at an early age, double vision is usually not experienced. Your child's brain may be able to suppress the vision out of the deviating eye which can also depress the visual development and maturation of that eye's visual pathway. This may permanently prevent the development of binocular vision and lead to amblyopia. Binocular vision is when our eyes work together to fuse the image input from both eyes into one and is called stereovision. Stereovision gives us the ability to appreciate full depth perception and is also what allows us to watch 3D movies. Furthermore, there is sometimes a social stigma associated with the misalignment that could hinder your child's social development, maturation and growth.
When is surgery indicated?
The most important aim of treatment is to improve the amblyopia and the vision out of the deviating eye. This can be accomplished with glasses, physical patching, or chemical patching. After this has been accomplished, we can consider surgical realignment. Surgical realignment is indicated if there is any level of amblyopia or if the deviation is occurring for more than 50% of the day. The aim of surgery is to lessen the deviation to a point which the patient will be able to control the deviation through fusional drive for the majority of the day. The preoperative assessment will require multiple visits to ensure consistent deviation measurements to optimize the surgical outcome.
What happens during surgery and is it covered by insurance?
Strabismus is a functional issue and the surgery is considered medically necessary. As such, it is covered under medical insurance. The surgery can be performed at an outpatient facility or ambulatory surgery center. Your child will be asleep and placed under general anesthesia. The affected eye muscles will be isolated and moved based on the preoperative deviation measurements. This will result int he realignment of both eyes. Immediate subjective improvement can be seen and your child may return to normal activities 3-4 days after surgery. Some patient's deviations continue to improve over the first 3 months with full visual recover and neuroadaptation.