Is getting your squint corrected straightforward? The answer, as with many medical procedures, is that it depends on the individual case. For some, particularly those with simpler forms of strabismus, the journey from diagnosis to successful treatment can be relatively straightforward. For others, particularly those with more complex forms of strabismus or those who have had the condition for many years, the path may be more complicated.
The medical term for a squint is strabismus. It is a condition where the eyes do not align properly and point in different directions. One eye may turn inwards (esotropia), outwards (exotropia), upwards (hypertropia), or downwards (hypotropia) while the other eye looks straight ahead.
Strabismus is estimated to affect around 300 million people around the world. The prevalence can vary depending on factors such as age, geographical region, and underlying health conditions; strabismus is more commonly detected in childhood but can also occur in adults due to trauma, stroke, or other neurological conditions.
Diagnosing strabismus early is crucial, particularly in children, because of its significant impact on vision development and overall quality of life.
Your Eyes and Your Brain
For most of us, both eyes work together to provide binocular vision – the ability to perceive a single, three-dimensional image. It relies on the coordination of the eyes and brain to combine the slightly different views from each eye into one unified perception.
This ability is essential for depth perception (helps in activities like catching a ball, driving, or navigating stairs), spatial awareness (understanding the relative positions of objects in space), and accurate judgment of distances.
However, in individuals with strabismus, the brain is unable to coordinate the eyes correctly. This misalignment can lead to a range of issues, from cosmetic concerns to more serious visual problems.
If left untreated, squints in children can lead to permanent vision loss. This is because the brain may start to ignore the input from the misaligned eye to avoid double vision, a condition known as amblyopia or ‘lazy eye’. The eye simply becomes unused, and the condition may be permanent. Due to the seriousness of amblyopia, children are now regularly screened in primary school for the condition.
The Impacts
Strabismus can significantly affect people’s lives beyond the physical misalignment of the eyes. These impacts are multifaceted, involving emotional, social, psychological, and practical aspects. Strabismus can lead to self-doubt, affecting confidence in forming personal or professional relationships.
Strabismus is often noticeable, which can lead to feelings of self-consciousness or embarrassment, particularly in social settings. Children with strabismus are often subjected to teasing or bullying, which can affect their social development.
The condition can contribute to mental health challenges due to social stigma or difficulty coping with the visual limitations. Adults and children may avoid social interactions due to discomfort with their appearance or fear of judgment.
Chronic eye strain or double vision can make daily tasks like reading, watching TV, or using a computer uncomfortable or frustrating.
Certain professions, particularly those that emphasise physical appearance or require excellent binocular vision (such as pilot, surgeon, or certain sports professionals), may be less accessible. Visual discomfort or double vision can hinder focus and efficiency in work or academic tasks. And difficulty judging distances can impact driving or even daily tasks like pouring liquids or navigating stairs.
Diagnosis of Strabismus
Strabismus is diagnosed through a combination of clinical evaluations and specialised tests. The aim is to assess the alignment of the eyes, their movement, and overall visual health.
A Visual Acuity Test measures how well each eye sees. An Eye Alignment Test involves one eye being covered while the patient focuses on an object. The uncovered eye’s movement reveals misalignment. A Refraction Assessment detects refractive errors like hyperopia (long-sightedness), which might contribute to the squint. A Binocular Vision Assessment evaluates depth perception.
How is Strabismus Treated?
Treatment for strabismus depends on factors such as the severity, underlying cause, and the patient’s age. The main goals of treatment are to improve eye alignment, preserve vision, and promote binocular vision (the ability to use both eyes together).
Here are the primary treatment options:
In some cases, particularly for children, correcting refractive errors with glasses can help align the eyes. Special prism lenses can also help redirect light and reduce double vision. However, this is only possible with mild squints. More severe squints would require prisms far too large to fit in standard lens glasses.
For children with amblyopia, patching the stronger eye can encourage the weaker eye to work harder and potentially improve alignment.
Eye Exercises (Orthoptics) can help certain types of strabismus (e.g., convergence insufficiency). Exercises improve coordination between the eyes and strengthen specific eye muscles. However, this is less effective for severe or structural misalignments.
Botulinum Toxin (Botox) injections are a temporary or trial treatment for some types of squints in adults. The Botox weakens overactive eye muscles, allowing better alignment. However, the effects last a few months, requiring repeat injections or surgery for long-term correction.
However, for many people, surgery is the most effective option.
Surgery
Surgery to correct strabismus is not merely a cosmetic procedure; it is very much a functional surgery that significantly improves vision and patients’ quality of life. However, not everyone acknowledges this.
While many private insurers will cover surgery, unfortunately, many consider strabismus a purely cosmetic issue, and they won’t cover surgery. Obtaining corrective surgery via the NHS can mean a wait time of around two years (the lack of perceived severity and the lack of experienced surgeons plays a part in this), and not every NHS Trust provides surgery.
In some cases, patients may simply be sedated, but surgery to correct strabismus is typically performed under general anaesthesia. Either way, most strabismus surgeries are performed as day cases; patients are able to go home on the same day as the procedure, which can take between 30 minutes and two hours.
During the surgery, the surgeon makes small incisions in the tissue covering the eye, gaining access to the eye muscles. These are then carefully repositioned to correct the misalignment.
Generally, patients recover quickly. Most people can return to normal activities immediately after surgery, but rest may be required.
In Summary
About the Author
Tina Kipioti (shown) is a Paediatric & Strabismus Consultant at Midland Eye. Midland Eye was founded by four ophthalmic surgeons who wanted to provide patients with a comprehensive, specialist service for diagnosing and treating all eye conditions. The team is a leader in their field and offers a consultant-only service to all patients requiring eye care or surgery.
Every consultant is qualified to treat common eye conditions such as cataracts, but each one also has a particular area of specialisation, ensuring that patients get the best possible outcome, no matter what the diagnosis.
Private patients can benefit from access to collaborative care and facilities with the latest and best technology. The clinic’s approach is designed to be convenient for people who lead busy lives and have limited time to seek medical advice and treatment.
To contact Tina and learn more about Midland Eye, please visit https://midlandeye.com/.