Introduction -- and experience
Otis
I will say "hello" from a person who is intermittantly "strabismatic",
i.e.,
under control.
In my own "best judgment" I induced this situation in myself
by my own "ill advised" habits as a 4 to 6 year-old child.
(I can discuss this in due course.)
My parents noticed that one eye would "drift out" when
I got tired.
I then was taken to an ophthamologist, and received to
two standard treatments:
1. Vision traing and eventurally
2. Muscle cutting.
While indeed difficult vision training has the best possibility
of "controling" the initial step into strabismus.
My main interest is in the prevention of nearsighedness,
as discussed on my site:
My personal opinion is that kids with their
nose on the page "decouple" one eye when they
read at 5 to 4 inches (-10 diopters). I judge that
kids that are taught to read at ages less that 6 years
can develop this "habit", and the secondary consequences.
The major issue for a parent is to recognize this problem
with the child -- before it gets out-of-hand.
I would be interested in your commentary and experience.
Best,
Otis
pw...@yahoo.com
heard once is that some types of amblyopia or strabismus might be
caused by the fact that, when the baby was brought home from the
hospital, they were placed in a cradle/bassinet that was placed against
a featureless wall rather than moved occasionally, and his head/foot
orientation never changed, such that one eye has just the wall a few
inches from his head, and the other eye has a view of all the rest of
the room, so that the first eye doesn't develop as well as the latter.
I've been checking out your http://www.myopiafree.com/ site. It's
interesting, thanks.
Otis wrote:
...
pw...@yahoo.com
...
> My personal opinion is that kids with their
> nose on the page "decouple" one eye when they
> read at 5 to 4 inches (-10 diopters). I judge that
> kids that are taught to read at ages less that 6 years
> can develop this "habit", and the secondary consequences.
Another possible cause of strabismus I've heard of is a difference of
refraction or astigmatism between the 2 eyes. I've assumed that,
because one of my eyes was astigmatic and the other not, that that was
part of the reason for my strabismus. FWIW, I *think* both of my eyes
were always 20/20 until a few years ago, when one (not the astigmatic
one) became slightly nearsighted, but perhaps also, in some folks,
maybe a difference in refraction between the 2 eyes could contribute to
it.
I wonder how many tropes have one eye that has astigmatism and the
other not. For that matter, are their any tropes who have 20/20 in
both eyes and no astigmatism?
Otis
Subject: "Proof" versus belief.
My interest was of course in my own profoundly "bad" habits
as a child -- and the eventual consequences for me.
In fact that affects my judgment about "medicine". And I
do "respect" them. By that I mean that they must
deal with us "after the fact".
There are very few that can "head off" a problem like
incipient nearsighedness, or incipient strabismus.
One thing I suggest is that we sort out a "phoria",
from a "tropia". Perhaps you could post your definition.
A moderate "phoria" is completely normal. They do
a "cover" test, and what happens is that one eye "moves"
with respect to the other. (This is a control system, and
the amount of change is the "offset" or "bias" of the
system.
Both eyes are within 5 minutes-of-arc when fused. But
both images must be (reasonably) clear for this fusion
to take place. (Thus your reference to amblyopia.)
I would also point out that "primates" also develop
"myopia" in the same way that we do -- for
much the same reason.
For monkeys captured in the wild, their "refraction"
has a distribution as follows:
Refractive state: +0.7 diopters
Standard Deviation: 0.7 diopters.
Any positive refractive STATE -- is excellent vision (with
a good retina).
Thus, if we grew up in that environment -- our refractive
state would be positive, and our eyes would pass
the DMV snellen.
I doubt that you would find any primate (in the wild)
with strabismus.
This does not "prove" the point -- but is an indicatoin
of the problem.
But monkeys in cages -- develop a moderate to
severe negative refractive STATE, because there
is nothing "interesting" in the distance to "look at".
There are no predators to kill them. So they look
at only near objects, i.e., their AVERAGE visual
environment is "near".
And so this "system" simply changes its refractive
STATE from positive to negative, and we
have blur at distance.
You have my judgment about myself, or "N = 1".
It may not apply to anyone else.
But I am pleased my parents thought enough
to "push" me with a stereo-scope. By that
process I did learn to "control" the situation.
But even today I can intentionally let either
eye "drift out". And of course I can
intentionally "fuse".
Maybe this will help with your son. I certainly
would check his reading habits.
I hope that it is still intermittent.
I know that I was "difficult" as a child -- in this
work -- and that it is frustrating for all
concerned.
I would strongly recommend (if still intermittant),
that he engage in outside sports.
If 20/20 (or 20/70 to 20/40 or better) getting a
mild plus for close work.
But those are my PERSONAL suggestions -- as
an engineer.
Good luck,
Otis
pw...@yahoo.com
hyper. I've seen it used before, and I don't mind being called a
'trope'.
Otis
As an engineer, I would "sort out" eye turn (as in the cover test)
as "normal" for slight out or slight in (i.e., exo or eso).
Virtually all normal eyes will do this, and from
a control system perspective that is how I would
define it.
When a eye goes "out" and stays out, or the eye-turn
is intermittant (the child is tired, or not paying attention)
the I would call it a "tropia".
But, as I know now, I "induced" this situation in myself
by that "nose on the page" routine some kids develop.
>From my perspective it is truly a deadly "habit".
It would be nice if the NEI tood this seriously, but
their general approach is that they do not
like to "interfere" with the person by providing
this type of advice.
I believe you started this discussion group because
your child had "started into" strabismus, and were
looking for PERSONAL judgment and opinions
on the subject.
I did have the "muscle-cut" -- because my parents
were concerned, and they were afraid I would "lose
the vision" it action were not taken.
The effect of THAT operation was to scare the hell
out of me. That was when I truly took vision-traing
seriously and worked hard at it. (For a 7 year-old
kid, that is.)
As always I think this is very DIFFICULT for
all concerned with it -- the doctor, the parents
and the child.
Best,
Otis
pw...@yahoo.com
surgery 8 years ago, at the age of 44, and so my eyes are closer
together now and I can fuse now if I want to. A doctor in India on
another forum claims that at my age, the surgery is only cosmetic, but
I maintain that now I can use my eyes in a more balanced way so, for
instance, the dominant eye no longer gets as fatigued as it did before,
so *that* improvement goes beyond cosmesis.
Otis
Dear Friend,
This is perhaps why "Doctors" have such a problem
with "us".
We are in fact all different.
I know my "judgment" of myself is private, and
my own concept -- related to the "control system"
concept.
I can certainly understand the logic of muscle cutting.
If they eye is not "brought in", by "exercise", and
the child "breaks" fusion for too long, then
the "out" eye will eventually go "bad".
I think that is the "driver" for muscle cutting and
it is indeed a difficult choice.
That is why I do not give anyone a "hard time" about
it.
But, personally (although I can never prove it) I think
my "bad habits" got me into it.
A difficult admission on my part -- but I think it is honest.
Best,
Otis
Brett Garrett
different perceptions of cause and effect --
or indeed, the cause and effect may vary.
I've always assumed that the reason I held my
nose to the page was because I was cross-eyed,
so I would do that to avoid double images.
In this way, I think my strabismus "caused"
me to become nearsighted.
(I did have surgery, apparently for intermittent
wall-eye, when I was four. So, I guess the surgeon
must have taken my eyes in a bit too far.)
Brett
Will Baldwin
wild have strabismus. I don't know about that, but I
think many dogs and cats do. Check the attached
picture of a dog who appears to have obvious
strabismus. I've seen many dogs that seem to have
exotropia.
It is said that many Siamese cats have esotropia. I
remember my parent's Siamese would move his head left
and right to apparently better judge distance and
depth perception before jumping or catching 'prey',
perhaps because he didn't have good binocular depth
perception. Moving my head from side to side to see
something in the distance is a trick I think I've used
before, since my sense of depth perception is pretty
poor otherwise. It's similar to triangulation, I
believe.
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Otis
Dear Brett,
Subject: Different preception -- always "difficult".
In fact I "remember" putting my "nose" on the page.
There was nothing "wrong" with my eyes -- just a PROFOUNDLY
BAD HABIT.
There are others who would say my eyes were "bad" and THEREFORE
I HAD to put my nose on the page.
But I say this in and honest friendly way.
>From a "control-systems" perspective, when you have
your nose 6 to 4 inches from the page, the two "images"
on each eye are very difficult to "fuse".
So in my opinion, the "brain" simply "gives up", and
one eye "drifts out".
In my personal judgment -- that is what I did
to myself.
But the other "effect", is that the eye controls
its refractive STATE to the AVERAGE of its
visual environment. And very SLOWLY your
refractive STATE moves from "plus" to "minus"
and you begin to get blur at distance.
But it depends on how you state a problem.
The OD or MD has no choice but to "fix" the
problem you present. And I can not blame
the for what they are doing -- because
they have virtually no choice.
But I always believe there is a "better way", even
though that "way" involves forcing the child
to keep his nose off the book.
And the above are the resons for it.
But as always this is my own personal opinion.
Best,
Otis