Thursday, May 03, 2012

Early intervention for optimal treatment of squint

Every case of squint can lead to loss of stereo vision
Ludhiana, 2nd May, 2011(Shalu Arora and Rector Kathuria) Generally squint is considered important only from the cosmetic point of view. It is true that deviated eyes do not look good on a person’s face. Added to this is the psychological and emotional distress. However this is not the only deficit caused by squint, says Dr Satish Thomas, pediatric ophthalmologist and squint specialist at Christian Medical College & Hospital, Ludhiana. It can cause decreased vision because of amblyopia if the squint is in one eye. In addition, every case of squint can lead to loss of stereo vision or 3 dimensional vision.  We can have 3D vision only when both the eyes function simultaneously. Children with squint suppress image from one eye in order to avoid double vision, but in the process lose 3D vision.

Squint is best corrected as early as possible after its onset. This is because 3D vision can only be restored if eyes are realigned within about a year of onset, which is before 2 years of age. Amblyopia or lazy eye can only be treated before 7 or 8 years of age. If squint is to be operated only for cosmetic purposes, then timing of surgery does not matter as much. A surgeon can operate and correct squint at any age, but unless it is done very early in life, the patient cannot obtain any binocular vision and 3D perception ability. This is a very important criterion for many professions and careers like sports, surgery, becoming a pilot etc. It is extremely important even for most simple activities like threading a needle. Unfortunately many patients who come to us late have been advised by many doctors that they have to wait until they get older to have squint operated. Most squints do not improve with time and if we wait in the hope of spontaneous improvement, everything will be lost except a chance of straight eyes.
Dr Satish Thomas says that for the last 7 years, ever since he returned from doing fellowship in pediatric ophthalmology and squint from Sankara Nethralaya in Chennai, he has been earnestly campaigning for early treatment of squint. It is encouraging that over the last few years more and more patients are coming in earlier for treatment. In the last year Dr. Thomas said that he has seen close to 100 new children with squint in the hospital who have been appropriately treated. Twenty of them have been operated upon and many of them have been corrected with appropriate spectacles and occlusion therapy. However, the number of adults coming in with congenital squints is also on the rise. During the last year about 50 adult patients underwent surgery for squint which they had from childhood. This is a reflection of the society’s understanding of the disease which needs to change. Almost all the varieties of primary squint originate in childhood and need to be operated early in life for maximum benefits. 

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