Strabismus (Crossed Eyes)
My toddler was just diagnosed with intermittent exotropia - a form of strabismus where one eye sometimes wanders out while the other is looking forward. Has anyone else in the community dealt with this with their child or themselves? I am keen to hear stories regarding treatment and long term outlook. What was your experience with treatment and how does the condition affect your life now? Is it merely a nuisance? Can you offer any tips on how to discuss the condition with your child, teachers, friends, etc.? Thanks. Worried about little eyes
I had surgery for this problem when I was 8 years old.Prior to that I could easily make myself see double. The surgery was successful and it is only on rare occasions and if I am very tired that I have to focus so I do not see double.I remember being in the hospital and having big white bandages over my eyes.When the bandages were removed every thing was way to bright for maybe a day or so. This was in 1960 so the treatment may be different now.My parents stressed a lot but it all turned out fine. Ellen
My 4 year old daughter and 6 year old son have both been seen at UC Berkeley's infant/toddler eye clinic for wandering eye/esotropia and vision correction for several years. Our O.D. has tried to treat my daughter's the eye turn with corrective bifocals but she's reached a point where her prescription is not controlling the eye turn and we've been referred to consult a pediatric surgeon for Stabismus surgery. My understanding is that she's not a candidate for eye patch therapy because her visual acuities are equal.
We have Kaiser insurance and have been referred to Dr. Eddy Tamura in Oakland for a consult next week. Has anyone else had a similar experience or feedback on the effectiveness of Strabismus surgery in toddlers?
I wanted to respond to your post as we chose surgery for our son diagnosed with strabismus as a 4 mo old. We patched for several months, and were frustrated at seeing no progress. We saw Dr. Susan Day at California Pacific in SF because our insurance would cover it, though I am familiar with the name of your prospective surgeon as well. At 9 mos, we agreed to do surgery, and Dr. Day performed it. I highly recommend consulting with her if you can with your insurance. The surgery was completely successful and he has not shown signs of strabismus since. We continue to do annual checkups with Dr. Day to ensure that his vision is as she expected. I am so glad we did it when we did, young as he was. He is now 9. Hope you get the answers you need for your children's vision. my best wishes. If you want to contact me directly for more details, feel free to email me. luisa
I had strabismus surgery when I was 3 in 1972 and it was very successful and --- in retrospect --- a good time to do it as I have minimal memories of the experience. I'm sure it's handled much differently these days but I do know they put splints on my arms for a couple days so I wouldn't touch my eyes. My mom tells me that was the hardest part but maybe they don't do that anymore. My wandering eye was very severe and the one surgery corrected it perfectly. I've been told by subsequent doctors that my surgeon did exactly the right thing in undercorrecting it, as in adolescence eyes turn outward and will make a final correction on their own. Absolutely no one can tell that back in the day you could only see the whites of my eyes. I'm very grateful and as an adult have only minimal near-sightedness corrected with lenses. I would say do it. Kids I knew later in elementary school who had uncorrected wandering eyes were teased severely and I never had to experience that. Fan of the surgery
My daughter, now 25, had surgery for strabismus at age 2 1/2. Altho her eyes are straight, she has weak vision in her corrected eye and has trouble seeing the world stereoscopically. It leads me to believe that another therapy, The Anat Baniel Method (ABM), might have helped her more. This method is beneficial for children with special needs and vision problems, like strabismus. Often, after several ABM lessons, the child's vision improves without surgery. Check it out at: www.anatbanielmethod.com Pam
Can anyone recommend a Pediatric Ophthalmologist in the East Bay to evaluate my 7-month old who may have a slight strabismus (crossed eye)? I want someone who is experienced and gentle with babies and communicates well with parents. I am a Kaiser member but would consider going outside of Kaiser for the right doctor. suzdriver
While Susan Day (In SF) has received rave reviews, we chose to stick with our Ped Ophthalmologist in the East Bay to save the trouble of crossing the bridge. Our son began seeing Otis Paul at Children's Hospital Eye Clinic when he was 1 yr. Dr. Paul isn't exactly warm and fuzzy, but he put my mind at ease and was willing (when pressed) to answer all of my questions. He diagnosed the problem and treated my son effectively (he has severe far-sightedness that presents like strabismus but isn't). Good luck - and if your child ends up with glasses, I highly recommend the solo bambini line! anon
Hi My son has exotropia/ambylopia and was under vision therapy for 3 yrs. His doctor now suggest a surgery. I visited couple of doctors for second opinion, and the advice was split. (some said go for a surgery, some said no!) (Already saw Dr. Day, Dr.Good.) Any advice on that? Can any one suggest a good doc in bayarea for surgery? Thx sally
Have you gotten an opinion from an optometrist? You say that your child has been in vision training for a while--normally it's optometrists that do the VT--what do they have to say? Also, you don't say how old your child is--that will make a big difference. I suggest getting an optometrist's opinion because as since they are non-surgeons, if they recommend surgery, you would probably feel better about going forward. And, if they recommend waiting, they may have other VT ideas for you to consider. anon
Hi there, My 2.5-year-old daughter has esotropia/ambylopia and will be undergoing strabismus surgery with Dr. Good next month. We've seen three pediatric opthalmologists (Dr. Day and Dr. Good being two of them) and we've seen a professor at the UC Berkeley optometry school for a consult about vision therapy. For us, there's consensus that surgery is the best option for our daughter. I feel for you... it would be SO hard if the doctors were split.
Are Dr. Good and Dr. Day of the same opinion? If so, I'd go with their advice. I've heard again and again from optometrists and various people at the UC Berkeley optometry school that Day and Good are the best pediatric opthalmologists around. In the case of the UC Berkeley optometry school, I believe they're the only opthalmologists they refer pediatric patients to.
If you haven't been to the optometry school at UC Berkeley, I highly recommend seeing Dr. Sarah Fisher. She runs the binocular vision clinic there and has a wonderful manner with children. She seemed more reluctant to turn to surgery than the opthalmologists, though she eventually did tell us that surgery was the best option.
If you have any other questions, feel free to email me. kht
I recommend Dr. Koseoglu as a highly skilled pediatric eye surgeon. He operated on my daughter to fix her strabismus when she was nine months old. She recovered quickly from the surgery and has had straight eyes ever since. Dr. Koseoglu has a somewhat stiff and formal manner, which might be offputting at first, but he's really good at what he does. We waffled about the surgery, too (it's never fun to watch your kid go through that, and I'm sure it's even harder with an older child than with a baby) but we're very glad we did it. Parent of a now-straight-eyed toddler
I suggest you see Dr. Douglas Fredrick at UCSF. He's head of the pediatric ophthamology department, and is absolutely fabulous, and highly recommended by those that work with him (ie. nurses in the operating room). He is a surgeon as well. Good luck! anon
Hi Sally, I can't give advice on your specific situation, I can only relate our experience for your consideration. Our son had surgery at 7 mos., performed by Dr. Day, for strabismus- he is now almost 4 y.o. and has no signs that he ever had any eye problems-- for weeks and months after the surgery I sometimes saw hiw eye turn inward and then correct itself, but now it's surely been more than a year since I've seen that happen. So of course, we are extremely happy and grateful that Dr. Day recommended early intervention (we patched for several months but saw no improvement) and that the surgery was a success. Good luck with your decision. Luisa
My 21-month-old daughter has lazy eye and strabismus (one eye crosses in frequently). The lazy eye has almost been resolved with 6 months of eyeglasses and patching, but we just saw her opthalmologist and found out that the strabismus is actually worse. Her dr. is prescribing less patching and new lenses, one with a bit stronger prescription than the other. We're going for a second opinion in a month to see how another highly regarded pediatric opthalmologist would approach the problem. I'm interested in hearing about other parents' experiences with resolving strabismus. Anyone had success with non-surgical methods? Thanks! Keri
Hi Keri, I don't have much to suggest in the non-surgical arena since our son had surgery at 9 mos. to address his strabismus, but I would recommend our pediatric opthamologist, Susan Day (415-202-1500), if you are looking for a second opinion and haven't seen her yet. She's well worth the drive to SF to see her and while she performed the surgery, she also has many clients who don't receive surgical options, and I'm sure she could offer good advice. Good luck. Luisa
Here is our experience with strabismus for what it is worth. My daughter was diagnosed with strabismus (accomodative esotropia) at age 3. In other words, she crossed her eyes because she was very farsighted.
It was difficult for me to deal with because the diagnosis seemed so vague and the treatment protocol seemed so nebulous. Because I had some conflicting information and recommendations from a very highly respected pediatric opthalmologist I ended up getting a second opinion from a second pediatric opthalmologist and then also from the UC Meredith Eyecenter. This did not help the situation as none of the doctors recommended the same prescription!! Suffice it to say that I was confused and lost. I finally settled with the doctor that I felt most comfortable with which was actually a third pediatric opthalmologist. We are lucky in the Bay Area to have so many of them!!
He prescribed glasses for my daughter with 3-month and then 6-month interval follow-ups. We also patched her stronger eye to encourage the weaker eye to respond to the glasses. It was very expensive early on because we had to change the prescription every 3-6 months. Her eyes were changing very rapidly. The prognosis for her was that the glasses would help with the crossing and that there was the possibility that she would outgrow the glasses at around age 8 or 9.
She is now 7-1/2. She wears her glasses religiously except while swimming and during gymnastics. She has gone from a two diopter difference between her two lenses to no difference. It used to be that her eyes would cross pretty quickly when she didn't wear glasses. Now she gets through an hour and half of gymnastics without crossing. She complains of double vision when she doesn't wear her glasses for a long time and when she is fatigued. Her lenses are still a 3+ which indicates that she's still pretty farsighted, but I think since the lenses are the same in both eyes they are more 'equal' then when she was younger.
Will she ever grow out of glasses? Don't know and I'm not sure that my daughter would be comfortable without them. She's had the same pair in the past 4 years and upgrading her to a new pair this week was a little traumatic.
I'm happy to say that she's had very little difficulties with the glasses vis a vis other children. Early on I taught her to explain to others that she wore the glasses to 'strengthen her weak eye'. The worst people were the older women who would take on a pitying tone about 'the poor child that needed glasses' - I could have slapped them, but generally I would just explain to them and say that all was fine.
Good luck to you and your child. I guess the need for surgery rest upon the root cause of the strabismus. For us it was never really an option. bergahoo
My six-month-old baby has crossed eyes (strabismus) and will probably need surgery. The pediatric opthalmologist she's been seeing (who would do the surgery), Dr. Koseoglu, is not mentioned in the archives. Does anyone have any positive or negative feedback on him?
When we asked our pediatrician if we could get a second opinion, she also referred us to Dr. Gordon Smith, whom we have not seen yet but who has positive recommendations in the archives. However, Dr. Smith is booked until April. If our baby is going to need surgery, we'd rather do it sooner (especially since the earlier it's done, the more chance there is of preserving some stereo vision). Would we be better off switching from Dr. Koseoglu to Dr. Smith, even though Dr. Koseoglu is the one who's been monitoring our baby's progress and we'd have to wait an extra few months? Parent of cross-eyed cutie
I am a resident in pediatrics at Children's Hospital Oakland. Dr. Koseoglu is an outstanding surgeon who is very perfectionistic & has a huge heart. His bedside manner is a little difficult to interpret because he speaks heavily accented English very quickly... however, I think you will be pleased with his care and surgery results. Best of luck. Katherine
Hello, Have no specific feedback on Dr. Koseoglu. But, what I wanted to talk to you about was the timing of the surgery. It's true that earlier rather than later is more likely to result in better stereopsis. But, children born with crossed eyes are unlikely to develop normal stereo anyway--in fact, are most likely to have none, regardless of outcome of surgery or timing of surgery. You need to balance wanting stereo vision for your child with risk of anesthesia and risk of needing a second surgery. Both risks are higher with earlier surgery. If you decide to delay, and I would advise delaying until about 1 year of age, you should be on a patching regimen to make sure that normal vision is developing in both eyes. For example, if it is always the left eye that turns in, that vision will not develop normally. So, occasionally patching the right eye to force your baby to use their left eye would be in order. Your doc can instruct you how to do this. And finally, this happens to about 1% of children, so you have lots of company! Good luck! Been there, done that
If possible, see if you can get a referral for a second opinion with either Creig Hoyt at UCSF or Susan Day in San Francisco. Both are excellent pediatric opthamologists/surgeons and are experts when it comes to strabismus. My son was diagnosed with strabismus (in one eye) at 2 months of age, was prescribed glasses by Dr. Hoyt, and after 2 years of wearing the glasses, the strabismus was corrected from wearing the glasses. Although we do not have personal experience with Dr. Day, we have friends who have been very satisfied with her and have highly recommended her. She is also recommended by our Berkeley pediatrician. Additionally, it is my understanding that surgery for strabismus does not correct vision, but only has cosmetic benefits as far as straightening out the eyes. Since your child is so young, please make sure that before she undergoes surgery that other options (glasses, patching) aren't a better first option for correcting the problem. Charlotte
It looks like my six year old will need surgery for her strabismus. We are looking for a surgeon in the Alta Bates Medical Group who does this well. Her opthamologist said the only person in our group who does this is Otis Paul, but I can't find any information about him in the archives or even on the California Medical Board site. We know about Dr. Susan Day, but she is not covered. Thanks for any info.
I don't know anything about Dr. Paul, and don't want to suggest anything bad about him but I do know about Dr. Day and that she is held in very high regard amongst ophthalmologists (I work for one in SF). For such an important surgery, it might be worth changing your daughter's medical group for a period of time in order to see the surgeon of your choice. Usually this just involves finding a primary care physician in the medical group the surgeon is in (likely BTMG) who will accept her as a new patient. You can likely change back to ABMG once the surgery and postop is completed. Find out how long the postop period is - I'm guessing about a year. Good luck! Cara
In my opinion, the best ped. oph. surgeons for strabismus in the Bay area are, in order of preference:
William Goode, M.D. Craig Hoyt, M.D. Susan Day, M.D.
I would not be comfortable with any of the other area ped. ophthalmologists performing such surgery on my child. It may be that you have to consider paying out-of-pocket for such a procedure if your insurance limits your choices.
While strasbismus surgery is a fairly straight-forward one, there are other, not unknown, complications involved with the procedure--splitting the rectus muscle, over/undercorrecting such that your child might need a re-op.
My daughter had Strabismus when she was a baby and we took her to see Dr. Susan Day, who is located in SF. Dr. Day is really wonderful, caring, and it's clear that she really knows her stuff. Toby
My son saw Dr. Susan Day at Pacific Medical Center in SF, 415/202-1500. (We were dealing with an injured nerve to his eye which eventually recovered). At one point we wanted a second opinion on proposed surgery (which we ended up postponing and avoiding). For that, we went to Dr. Creig Hoyt at UCSF, 415/476-1289. We were pleased with the treatment of Cynthia
We recently brought our son to see a woman named Dr Susan Day at CPMC. She was very highly recommended and spent a lot of time explaining things. It turns out that our son won't need surgery, but she is supposed to be very good. Jennifer
My optometrist husband said that a recommendation for an ophthalmologist will depend on the nature of the eye problems and the age of the child. He suggested your friend might start at the UC Opt School (642-2020), (the infant and toddler clinic, if the child is younger), and have them suggest an appropriate referral. The best docs in the Bay Area are associated with UCSF/Stanford Medical Center, and if the problems are very serious, the child may end up seeing someone there. Karin
My three-year old daughter has just recently developed strabismus (aka crossed-eyes). Does anyone have recommendations for how to help her keep her glasses on, encourage her to use them, etc.? Has anyone had experience with toddler strabismus and can share their experience with treatments with me? Thanks in advance!
Regarding strabismus in a toddler. I have two children with strabismus, one diagnosed at 18mos and the other at 9 mos. Both have worn glasses since diagnosis. We saw Gordon Smith M.D. in Walnut Creek and he was great. Both kids started with plastic frames that either had a strap across the back or wrapped around their ears. We weaned them onto the glasses, wearing them for short periods of time in the beginning and then for longer periods. By the end of 2 weeks each child was wearing her glasses regularly. At some point they realize the benefit and usually ask for the glasses. My kids are now 6 1/2 and 2 and they wear their glasses easily. Ruth
I want to reassure you that since my daughter got glasses at 3 1/2 (she is now 6 1/2) we have never had trouble convincing her to keep her glasses on. I too thought it would be a struggle but she has never complained. Maybe because it helps? She has the accomodative esotropia variety of strabismus and sees Dr. Susan Day in SF, who is extremely positive and tells her she has these glasses to help her eyes grow in the right way. Dr. Day told her from the beginning that if she wants a break from her glasses she should just tell mom or dad and we'll keep them safe for her. When she does ask for a break (not very often at all--and usually because the little nose pieces are out of alignment and rubbing her the wrong way) I tell her after 5 or 10 minutes that it's time to put them back on and she always agrees. I assure you she is not this compliant on everything, so it's not like we just have a very placid child, I just think glasses at this age are not as big a deal to them as they are to us. Recently while sledding in the snow I let her have them off for a couple of hours at a time because they were a pain (and could have been a danger) in this instance, but I have never found them to get in the way of any other activity-swinging, monkey bars, running, tumbling, dancing, horse-play, etc. Good luck! A.
Our son is 1 1/2 now and has been in glasses since he was 1, to help correct strabismus. They wrap around his little ears (I think these are called comfort cables), but we also attached a colorful cord to each side, which we got at the eyeglasses shop, so that if he tries to hurl the glasses to the ground, they just dangle around his neck instead. The cord can be tightened in back to help keep the glasses from slipping down his nose. He is good about keeping them on--we just insist he wear them, like clothes, and he got used to them remarkably fast. Sarah