Dominick M. Maino, OD, MEd, FAAO, FCOVD-AProfessor of Pediatrics/Binocular Vision

Illinois Eye Institute/Illinois College of Optometry

Optometrist, Lyons Family Eye Care

Accommodative Esotropia

What is Accommodative Esotropia?…Accommodative Esotropia is a condition (strabismus) in which a person is unable to align both eyes simultaneously under normal viewing conditions. When both eyes do not point at an object at the same time, it results in the appearance of one eye "turning" inwards in relation to the other. This eye turning may be constant, in which an eye turns all the time, or it may be intermittent. It may also alternate so that either eye turns at any given time

What causes an Accommodative Esotropia?

…Accommodative Esotropia is caused by an overactive focusing (accommodation) system. This may occur because of a moderate to high amount of hyperopia (farsightedness). When you try to compensate for the uncorrected farsightedness by using your focusing system an eye turn inwards results. Neurologically when you focus, your eyes also turn in and conversely, when your eyes turns in, your focusing system is activated as well.

What causes an Accommodative Esotropia?

…Accommodative Esotropia is also caused by a focusing (accommodation) system that over-reacts to a stimulus even when minimal refractive error is present (only small amounts of farsightedness). Let’s say that for a near task, “X” amount of focusing is needed, but with accommodative esotropia much more focusing results, which in turn causes an eye turn inward.

What causes an Accommodative Esotropia?

…So Accommodative Esotropia can be caused by…

1.) Uncorrected Farsightedness (hyperopia)2.) Over-reaction of the focusing system even when only small amounts of refractive error is present.

(High accommodation-convergence accommodation ratio AC/A)

When does Accommodative Esotropia Occur?

…Accommodative Esotropia usually starts between the ages of 2 and 4 years. It can appear intermittently (occasionally) and then more and more frequently until it becomes a constant inward eye turn.

What is a Pseudostrabismus?…A Pseudostrabismus (false eye turn) can fool parents and doctors so that they believe an eye turn is present when there is no eye turn. This is usually noted in infants where the bridge of the nose and other anatomical features around the eyes give the impression an eye turn is present. If, as a parent, you think an eye turn is present, always bring your child in for a comprehensive vision examination.

Pseudostrabismus

Light reflex central

Evident epicanthal folds

Flat nose bridge

What Symptoms are Associated with Accommodative Esotropia?

…Accommodative Esotropia… is often associated with a variety of symptoms, including seeing double (diplopia),

difficulty judging distances, eyestrain, headaches, blurred vision, sleepiness, difficulty concentrating,

movement of print while reading, and loss of comprehension after short periods of reading or

performing close activities. … A person with a constant eye turn may only notice a few of these symptoms or

none at all…. Children do not always tell you if symptoms are present.

What is the Prevalence of Accommodative Esotropia?

…The estimated prevalence of strabismus in the general population is from 2 to 5% …5 to 15 million individuals in the United States may have this condition…..About 2% of the population has an accommodative esotropia

At What Age Can You Treat Strabismus?

Despite what you may hear from those who have not kept up with the latest research, strabismus can be treated AT ANY AGE!

Children, Adults and Seniors may all benefit from treatment.

How Do You Treat Strabismus?

Treatment always starts with the best prescription glasses possible. These glasses may include bifocals and prism. Both can help the eye stay straighter. This prescription may change over time as the functional vision problems improve.

How Do You Treat Strabismus?

Optometric vision therapyVision therapy is a doctor-supervised, non-surgical, customized program of therapeutic procedures designed to prevent, remediate, and/or enhance vision problems and/or improve visual skills.

Vision therapy can include the use of lenses, prisms, filters, computerized procedures and non-computerized instrumentation. The goal of vision therapy is to treat vision problems that cannot usually be treated successfully with eyeglasses, contact lenses and/or surgery alone, and help individuals of all ages achieve single, clear, comfortable binocular (two-eyed) vision using the scientific principles of neuroplasticity.

How Do You Treat Strabismus?

Unfortunately, many doctors recommend surgical intervention before trying other forms of treatment such as glasses and vision therapy. Surgery is always an option, but should usually be the last thing suggested and not the first.

Surgery

How Do You Treat Strabismus?If surgery is recommended by your doctor, probably the best approach is what is used by other specialties. If your doctor was recommending a knee replacement, he would usually have you do physical therapy and other pre-surgical activities first, then the surgery and finally more physical therapy. Unfortunately, this seldom happens when you have strabismus surgery. Strabismus surgery, especially for accommodative esotropia, should probably be the last treatment option considered and not the first. The treatment sequence should then be vision therapy, surgery (if needed), and then post-op vision therapy.

Strabismus Therapy FAQs

Often includes bifocals and prism

• Hand-eye• Focusing• Eye

movement

• Same as noted in monocular phase and anti-suppression

• Same as noted previously plus convergence and divergence therapy

• Hand-eye, eye movement, focusing, convergence and divergence therapy done simultaneously

MonocularGlasses

Biocular BinocularIntegration &Stabilization

If needed, surgical intervention may be recommended between monocular and biocular or biocular and binocular phases.

Vision Therapy FAQs

Tell me about home vision therapy

Home vision therapy can vary from doctor to doctor. I recommend a minimum of 20 to 30 minutes per day, 5 days per week. Some doctors do not prescribe home vision therapy, but I find that the in office therapy program progresses at a faster rate of speed if home therapy is conducted.

Vision Therapy FAQsTell me about in-office vision therapyIn-office vision therapy can also vary from doctor to doctor. I recommend one therapy session per week for 45 minutes. National Institutes of Health, National Eye Institute supported clinical trials have shown in-office vision therapy to be the most successful therapy for binocular vision problems.

Vision Therapy FAQs

What does vision therapy cost?

This will vary from office to office but is comparable in cost to occupational, physical, and/or speech/language therapy. Some offices charge for each individual visit while others have a “program” similar to that of having braces applied by your dentist.

Vision Therapy FAQsDoes insurance cover the cost of vision therapy?

Yes. No. Maybe. Some time ago most insurance would have picked up about 80% of the cost. Then my impression was that the insurance companies just seemed to stop reimbursement for therapy. Now they are once again picking up some of the cost.

Know your insurance policy. Do not take “NO” for an answer. Your doctor’s office will usually assist you when it comes to insurance, but it is ultimately your responsibility.

Strabismus FAQs

Where do I learn more about strabismus?

Go to:

American Optometric Association: Care of the Patient with Strabismus: Esotropia and Exotropia

College of Optometrists in Vision Development:

STRABISMUS AND AMBLYOPIA; Esotropia

Vision Therapy FAQsWhere do I learn more about treatment, especially from a parent’s or patient’s point of view?

Go to:

Parents Active in Vision EducationVision Therapy Parents Unite!

Vision Therapy Changed My LifeConvergence Deficiency/Insufficiency

Living with Diplopia

Vision Therapy FAQsWhere can I get additional information on pediatrics, binocular vision, vision therapy, children wearing glasses and more?

MainosMemosVision Therapy at Lyons Family Eye Care

VisionHelp blog

COVD blog

Discovering Vision Therapy blog

Wow Vision Therapy blog

SOVOTO

Little Four Eyes

Vision FAQs

Strabismus Surgery Outcomes

What is convergence insufficiency?

What is lazy eye?

FAQsWhere can I get additional help?

Call or email us at Lyons Family Eye Care.

Lyons Family Eye Care3250 N. Lincoln Ave.Chicago, IL 60657Click here to view a map of our location

Phone Number: 773-935-2020Email: info@lyonsfamilyeyecare.com

“LIKE” us at Vision Therapy at Lyons Family Eye Care

This PowerPoint template was provided free by www.presentationmagazine.com

LFEC FAQsWhere can I get additional help?

More information about Lyons Family Eye Care

Wild Chicago Harlem Shake Artists LFEC Jingle

“LIKE” us at Vision Therapy at Lyons Family Eye Care

“LIKE” us at Lyons Family Eye Care

This PowerPoint template was provided free by www.presentationmagazine.com

About Dr. Stephanie Lyons

About Dominick M. Maino, OD, MEd, FAAO, FCOVD-A

About Megan Westergren, OD