Interventions for infantile esotropia

Time trends over five decades, and recent geographical variation, in rates of childhood squint surgery in England

“…The current absence of good evidence for the treatment of strabismus is illustrated by the Cochrane review which failed to recruit any randomised trials for meta-analysis when assessing the effectiveness and optimal timing of surgical and non-surgical treatment options for infantile esotropia 26. This lack of an evidence base has been a reason for controversies related to strabismus surgery including age at surgery, type of procedure and the effect of surgery on amblyopia.…”

Stereo vision and strabismus

“…13 Where strabismus therapy succeeds in restoring stereo vision, this proves that the patient has excellent and stable binocular alignment, and that the necessary sensory cortical mechanisms have been preserved. Figure 1 The optic axes of each eye are shown with solid lines.…”

“…Thus, good stereoacuity with cyclopean stimuli is the most demanding achievement of binocular vision. For this reason, as the Cochrane review on 'Interventions for infantile esotropia' states, 13 a measurement of stereoacuity is regarded as the gold standard for diagnosing the presence and quality of binocular vision. It is a key component of outcome measures in most studies of interventions for strabismus and amblyopia.…”

“…77 These conclusions are supported in other forms of strabismus such as accommodative esotropia and intermittent exotropia. In all cases, early intervention is associated with better stereo vision, 13,78 and the critical factor is the duration of the misalignment. Fawcett et al 78 conclude that fine stereoacuity is likely to be permanently impaired by a constant misalignment that persists for longer than 4 months.…”

Strabismus surgery before versus after completion of amblyopia therapy in children

“…Stereoacuity also can be achieved in those undergoing surgery after six months of age, again with better results associated with earlier surgery: the ELISS Study, a large multi-center, non-randomized trial, reported that children who underwent strabismus surgery at 20 months of age had better gross stereopsis than those who had surgery at 49 months of age; the first group had a larger number of reoperations to get to the end point of good alignment (Simonsz 2005). However, a Cochrane review examining interventions for infantile esotropia (crossing of the eyes) did not identify any randomized controlled trials (RCTs) conducted to inform the optimal age for performing strabismus surgery, highlighting the need for further research to improve the evidence for timing of surgical intervention to correct strabismus in childhood (Elliott 2013). …”