Abstract
Surgery to align a deviated or strabismic eye is often done for both functional as well as cosmetic reasons. Although amblyopia is often an impediment to regaining full binocularity in strabismics in general, intermittent exotropes, because their deviation is intermittent, have no amblyopia and some degree of stereopsis. Binocular function, including a balanced ocular dominance, could be expected to be normal after surgical correction if normal levels of stereopsis and visual acuity are postsurgically achieved. Here we used a binocular phase combination paradigm to quantitatively assess the ocular dominance in a group of surgically corrected intermittent exotropes who have normal stereo and visual acuity as defined clinically. Interestingly, we found significant interocular imbalance (balance point < 0.9) in most of the surgically treated patients (8 out 10) but in none of the controls. We conclude that the two eyes may still have a residual sensory imbalance in surgically corrected strabismus even if stereopsis is within normal limits. Our study opens the possibility that a further treatment aimed at re-balancing the ocular dominance might be necessary in surgically treated intermittent exotropia to provide more efficient binocular processing in the long term.
Highlights
Strabismus with normal clinical visual acuity and stereopsis, is important to establish whether they are “binocularly normal” in all respects
Only two surgically corrected intermittent exotropes exhibited a balanced pattern expected of normal controls, while the remaining surgically treated patients exhibited different extents of sensory eye imbalance
Our results reveal that a functional eye imbalance still remains even in surgically corrected cases that have clinically normal stereopsis
Summary
Strabismus with normal clinical visual acuity and stereopsis, is important to establish whether they are “binocularly normal” in all respects. To answer this question, we quantitatively assessed the sensory eye dominance in a group of 10 teenagers/adults who had intermittent exotropia with no acuity loss prior to the surgery and who were, postsurgically, orthotropic or having a horizontal heterotropia of 10 prism diopters or less with normal stereopsis (defined clinically as less than 100 arc sec in the clinical stereo tests using Random-dot stereograms and Frisby). We used a binocular phase combination paradigm[26,27] to assess the interocular contrast difference that was needed to result in a balanced binocular combination. Our study opens the possibility that a further treatment aimed at re-balancing the ocular dominance might be necessary for efficient binocular processing and binocular stability
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