Specialized Approaches For Strabismus Treatment

This article was published on Forbes on 10/30/2023.


This story is part of a series on the current progression in Regenerative Medicine. This piece is part of a series dedicated to the eye and improvements in restoring vision. 


In 1999, I defined regenerative medicine as the collection of interventions that restore to normal function tissues and organs that have been damaged by disease, injured by trauma, or worn by time. I include a full spectrum of chemical, gene, and protein-based medicines, cell-based therapies, and biomechanical interventions that achieve that goal.


Strabismus is a visual disorder that affects people globally and has an estimated prevalence of 1.93%, which means that about 2 in every 100 people have this condition. It occurs when the eyes are misaligned and do not point in the same direction, leading to physical changes in appearance, disrupted visual development and function, negative impacts on overall health, and psychological distress.


Understanding Strabismus


Individuals who have strabismus face several challenges. They are at an increased risk of vision loss and injury. Furthermore, they often find it difficult to receive appropriate care and lack proper information among ophthalmologists and primary care providers. Although the exact cause of this condition is unknown, it may be due to muscle tension, nerve damage, or abnormalities in the brain that control eye movement. Some research suggests that genetics may also play a role in the development of strabismus. 


Various risk factors can lead to strabismus, such as premature birth, low birth weight, and cerebral palsy. Strabismus is also more common in certain pediatric conditions, including Down syndrome, retinopathy of prematurity, and hydrocephalus. While strabismus can be a purely cosmetic concern in some cases, untreated patients can experience functional vision loss and visual input suppression in one of the eyes, leading to permanent vision impairment.

Strabismus can be classified into different types, including esotropia, exotropia, hypertropia, and hypotropia. Esotropia involves an inward deviation of one or both eyes, while exotropia involves an outward variation of one or both eyes. Hypertropia and hypotropia involve upward and downward deviation of one or both eyes, respectively.

Common Treatments for Strabismus


Strabismus treatment is a comprehensive approach that has multiple objectives. The primary goals of this treatment are to improve the alignment of both eyes, enhance visual clarity, and foster binocular vision. Proper alignment ensures that both eyes work harmoniously, reducing eye strain and discomfort while improving visual coordination. Optimizing optical clarity provides a more immersive and wholesome visual experience, enabling patients to see objects clearly without distortions. Lastly, promoting binocular vision offers enhanced depth perception and a comprehensive understanding of spatial relationships.


In addition to traditional methods such as glasses or contact lenses to correct refractive errors, other specialized approaches can be employed to address the issue of the eye misalignment. These methods may include special drops, lenses, or even eye patching, which have proven effective in straightening misaligned eyes. In some cases, surgery may be considered the most optimal and effective long-term solution for treating strabismus. One novel treatment approach related to surgery is the use of adjustable stitches.


Adjustable Stitches for Strabismus


Adjustable sutures play a crucial role in strabismus surgery. The stitches allow for precise adjustments of extraocular muscles to optimize alignment during postoperative recovery. A comprehensive study by the American Academy of Ophthalmology evaluated the impact of adjustable sutures on motor alignment outcomes in patients undergoing strabismus surgery. 


The technique used in this surgical procedure involves the flexibility of adjusting sutures either immediately after the surgery or within a few days, with or without sedation, to ensure optimal results. It is worth noting that both adjustable and non-adjustable suture techniques have yielded favorable outcomes in motor alignment in most cases, indicating the effectiveness of both approaches. However, the study suggests further research into the viability of these sutures before making them a common practice. Additionally, another treatment option is to avoid surgery entirely by using Botox.


Treatment of Strabismus with Botox 


Botulinum toxin type A (BTXA) is a neurotoxin commonly used for treating strabismus, a condition where the eyes don’t align correctly. By injecting BTXA into the extraocular muscles, we can restore ocular alignment. Generally, the effects of this injection become apparent within 1 to 3 days. 


The technique for administering BTXA may vary based on whether an open or closed conjunctival-based approach is used and whether electromyographic guidance is employed. This procedure can be conducted in an operating room or an office setting. Evaluating the injection of BTXA for horizontal strabismus is crucial to identify any temporary or permanent adverse effects associated with this treatment.


Based on a review by the American Academy of Ophthalmology, extraocular muscle injection of BTXA is an effective method for achieving successful motor outcomes, akin to eye muscle surgery for horizontal strabismus. The consistency of results across the studies included in the review is notable. Three of five comparative studies indicated successful motor outcome rates of approximately 60%.


Looking Forward


Strabismus is a complex condition affecting individuals of all ages and significantly impacting their quality of life. While the exact cause of this condition is unknown, various risk factors can lead to the development of strabismus. If left untreated, strabismus can lead to permanent vision impairment. 


The primary goals of strabismus treatment are to improve the alignment of both eyes, enhance visual clarity, and foster binocular vision. Treatment approaches may include traditional methods such as glasses or contact lenses, specialized techniques such as special drops, lenses, or even eye patching or surgery. 


Recent advances in strabismus surgical techniques, such as adjustable sutures, have shown promising results in achieving optimal outcomes. Similarly, Botulinum toxin type A (BTXA) injections are an effective treatment alternative for horizontal strabismus. 


As the research progresses, we will likely see novel approaches and improvements in current treatments that will provide better vision and outcomes to those with strabismus. 

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