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Oculomotor Examination

Double Vision, Strabismus, Convergence Insufficiency and Beyond...

Some patients have double vision due to congenital/developmental or age-related deficits like convergence insufficiency (inability to cross the eyes), accommodative insufficiency (inability to focus the eyes), an eye turn/strabismus (inability to align the eyes) or a cranial nerve palsy.  Eyes may turn inwards (esotropia), outwards (exotropia), or vertically (hypertropia/hypotropia) also known as a vertical phoria. 

 

This examination is specifically tailored towards identifying the cause of double vision, how the double vision may be impacting activities of daily living like reading, computer, walking, etc, and creating a personalized treatment plan for the patient. 

Prismatic Evaluation 

Dr Theis will use prism to measure how big the strabismus/eye turn is.  She tests the eye turn both at distance, and near, as well as in different gazes like up, right, left and down, to see how the eye turn behaves as the patient moves their eyes.  Every case of double vision is different and requires an individualized approach.  Dr Theis uses her clinical expertise to determine how much prism your eyes need to see single vision at all distances.  Prescribing prism is an art - just because you may have tried prism glasses before and they didn't work, doesn't mean that prism can't work - it just means that power of prism wasn't enough and further evaluation needs to be done.

Fusion

Fusion is the ability for the brain to take the images from each eye and fuse them together into one concept.  Some people can "fuse" at certain distances and have aligned eyes, but lose their fusion at other distances causing them to have intermittent double images.  If an eye turn is present long enough, the brain may turn one eye off or "suppress" an eye's image in order to get the double vision to go away when the eye turns.  This is common in pediatric strabismus when an eye is turned and a child is unaware.

Depth Perception

There are different types of depth perception or stereopsis.  Depth perception is important for interacting in our environment - whether it is hiking on a trail, playing sports, or reaching for a glass on the kitchen table - accurate depth perception requires precise eye alignment.  Sometimes even small, non-cosmetically visible eye turns can cause depth perception difficulties

Vergences

Vergences are eye movements that allow the eyes to coordinate over a range of distances and still maintain single vision.  When a person moves their eyes from up close to far away they are using divergence, and when a person moves their eyes from far away to up close they are using convergence.  Each individual must have an ample amount of vergence to compensate for any eye misalignment.  If vergence eye movements are not functioning correctly, the patient may have intermittent double vision.  Vergences can be trained/improved with orthoptic vision therapy.  

Treatment Options

There are multiple treatment options for patients with strabismus - the specific type of treatment depends on multiple variables including the age of the patient, age of onset of the strabismus, how large the strabismus is, and the distances/visual tasks at which the patient is struggling to compensate for their eye turn.  Some options are listed below!

Optometrist testing step vergence using prism bars with teenage female patient.jpg

For some cases, prismatic correction in glasses can alleviate double vision.  Click above to learn more!

hands touch screen of digital tablet with ophthalmologist and optometrist icons symbols, o

For patients with small strabismus, convergence insufficiency, and intermittent double vision, we offer home-based vision therapy individualized to the patient.  From pencil and paper tasks, computer software, to virtual reality, we offer doctor-driven rehab for cases that qualify.  Click above to learn more!

Some cases of strabismus require surgery.  Dr. Theis is not an ophthalmologist and does not perform surgery.  However, she is honest with patients about the necessity of surgery in some cases, and will recommend it when it is appropriate.  

Strabismus Surgery Second Opinions

Prior to moving to Richmond, VA, Dr. Theis worked directly alongside some of the best pediatric ophthalmologists, neuro-ophthalmologists, and oculoplastic surgeons in the country. She has extensive experience counseling, discussing and co-managing strabismus surgery cases.  To put it frankly - some strabismus cases require surgery but not all.  

 

Dr Theis is happy to provide a second opinion on the necessity of surgery for concerned patients and families versus the ability to remediate the eye turn with vision therapy.  While surgery can be a scary option, and many parents may prefer to pursue vision therapy instead, Dr Theis will recommend what is best for the patient - which is sometimes vision therapy, sometimes surgery, and in some cases a combination of both. 

 

Additionally, some patients need strabismus surgery but need to wait for a few months/years before they can become a candidate due to the nature of their strabismus (trauma, operation) etc.  Unfortunately, many of these patients have double vision while waiting to stabilize for their procedure and have difficulty with an eye patch due to skin sensitivity, light sensitivity and difficulties with depth perception.  Dr Theis has extensive experience stabilizing these types of strabismus with temporary fresnel prisms until the patient's eye turn has stabilized and is ready for surgical correction.

crazy female eyes with strabismus of pretty woman or cute girl at optician with mad, comic
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