all know there is no truth to the tale: if you cross your eyes, they
will stay that way. However,
nearly five percent of adults suffer from misaligned eyes or strabismus.
More commonly referred to as a wandering, crossed, or lazy eye, this
condition results in eyes that look in different directions. The eyes
are unable to focus simultaneously on a single point and thus there is
no binocular vision. If this condition has been long-standing (onset
prior to age 8 or so), the brain will learn to suppress or turn off one
eye to avoid double vision. For a child, this suppression can lead to
amblyopia or poor vision in one eye if not treated. If the strabismus
develops as an adult following the age of visual maturity, then
persistent double vision is a major problem.
State University’s John Baker, MD, clinical professor of
ophthalmology, recently spoke about adult strabismus in his presentation
of the second Marshall M. Parks Lecture at the annual meeting of the
American Academy of Ophthalmology.
of ophthalmology at Children’s Hospital of Michigan and a faculty
member at the Kresge Eye Institute, Dr. Baker is among a cohort of
ophthalmologists who are providing evidence that correction of
strabismus as an adult offers much more than just a cosmetic advantage
to patients. Treatment can improve depth perception and field of vision
in addition to enhancing self-esteem, communication skills, driving and
a better chance for career advancement.
(ophthalmologists who deal with strabismus) are often told that
correcting adult strabismus is only a cosmetic procedure,” Dr. Baker
said. “The normal function of the visual system requires that both
eyes are aligned so they can look at the same object at the same time.
Our goal is to restore the eyes to this position for normal
generally requires eye muscle surgery, which can be an insurance problem
for some adults. Dr. Baker and his colleagues are showing, however, that
there are valid functional reasons to correct misalignment in adults as
well as children. For the adult with recent onset strabismus, double
vision may be an incapacitating problem. However, even if double vision
is not present, strabismus sufferers can frequently regain binocular
vision. For those patients whose eyes are crossed inward, aligning the
eyes can result in an expanded peripheral visual field of up to 30
degrees, said Dr. Baker.
are also psychosocial factors associated with strabismus. Full awareness
of the extent of the problem is very important, said Dr. Baker. It can
greatly impair self-image, interfere with communication, limit job
advancement and initial hiring, as well as affect personal interactions. In a recent study of adult strabismus patients, 85 percent
reported that they had problems with work, school and sports because of
their strabismus. In the same study, 70 percent said it had a negative
effect on their self-image. Fifty percent rated their eye alignment
problem as moderate or severe and they reported being anxious and
“We need to study the psychosocial effect of strabismus correction on these individuals preoperatively and at six and 12 months postoperatively,” Dr. Baker said. “We need to reach comprehensive ophthalmologists, optometrists, and primary care physicians with the information that their adult patients with strabismus can be greatly helped functionally and that correction is far from only cosmetic.”