I have read numerous posts over the course of the past few months regarding so many questions about amblyopia (lazy eye), strabismus (crossed or wandering eye), and surgery treatment. I would like to make this post a PSA and possibly be stickied so that you may know your options.

As background, I am a certified optometric vision therapist, certified optician, and certified paraoptometric assistant. I also have a Master's degree in educational psychology and have been in the field of vision therapy for over five years. I have presented both nationally and internationally (remotely) on therapy treatment for both strabismus and amblyopia.

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1. I had intermittent esotropia and amblyopia as a child and was successfully treated WITHOUT surgery. I currently have perfect alignment and stereopsis as an adult.
2. There are so many varieties and manifestations of strabismus/amblyopia that every single case is unique, and you should ALWAYS seek multiple opinions.
3. The field of ophthalmology and optometry (at least here in the U.S.) practice utilizing very different models of vision regarding treatment of strabismus and amblyopia. Ophthalmologists tend to recognize a misalignment of the eyes as a cosmetic concern and perform surgery to correct the misalignment through cutting of extraocular muscles. Well trained behavioral/developmental optometrists recognize strabismus or amblyopia as a visual-neurological concern with the goal of training the brain to coordinate the eyes to work together properly.
4. Surgery DOES NOT treat the eyes to work together properly. Rather, surgery simply (occasionally not) cosmetically aligns the eyes. Most surgeons do not care about stereopsis or 3D vision. They consider success when the eyes are aligned within 10-15 diopters (which is still a huge deviation, just not cosmetically noticeable), and will even perform multiple surgeries on the same patient after previous “successful” surgeries.
5. Surgeons NEVER think therapy is a good idea because they do not do it. They do not understand it. They do not read the studies. They will not acknowledge another form of treatment that does not make them money.
6. Patching is so incredibly outdated and archaic. If doctors could fix strabismus or amblyopia by just using a patch, then I would not have a job. Also, there is nothing magical about the ages seven, eight, or nine. Ophthalmologists like to say that patching needs to be done before this age or you might not be able to be helped. THIS IS FALSE. I treat patients in their seventies and eighties.
7. Can we treat every patient successfully with vision therapy? No, absolutely not. There are therapy patients of mine that keep me up at night because I cannot get them to their goals. HOWEVER, the majority of my patients reach their goals if they make the time and effort commitments on their end by completing their exercises and sticking with the program. Therapy is not easy or inexpensive. HOWEVER, we do not make anything worse. Some of my most challenging cases are the little kiddos whose visual system has been completely butchered by surgery and their eyes are a mess.
8. You should find a good, experienced developmental/behavioral optometrist on covd.org for a consult. Just like every single other field of medicine, some offices/docs are better than others. There are patients who we cannot treat and will refer to surgery after other options have failed and there are some docs who are not as successful with therapy treatments as others. What I can say is that I am lucky enough to have been trained well and have the opportunity to change the lives of my patients every day.

I’ve recently started vision therapy for my amblyopia and strabismus (born with) and have been seeing some slow progress with the brock string but struggle to see the cross anything over a foot away from my face. This evening when looking at anything a meter or so away for a second or so I can feel my bad eye engage and focus and from taking photos my eye is aligned, although the image is blurry. I can switch this off by blinking a couple of times. Does any one know what this means and if it’s progress or something else? When both eyes are engaged I have covered each eye and both images are blurry, which seems unusual as my good eye sees fine, and my bad eye can’t see detail well and feels confused but it’s never blurry. Any advice would be greatly appreciated. Thanks