Background 

Occasionally, co-management involving both optometry and ophthalmology is needed to optimize treatment outcome for the strabismic patient.

Methods 

JB, a 47-month-old consecutive esotrope presented to our clinic. Two previous attempts to surgically correct her exotropia had failed and the parents sought another treatment approach. We recommended optometric vision therapy (VT) to improve sensorimotor fusion before any further surgery. After 31 VT sessions (bi-weekly for a time, then weekly), before a third scheduled surgery, sensorimotor fusion was good in the amblyoscope, but unstable with neutralizing prism in free-space. We recommended surgery be postponed, but the family proceeded. Esotropia recurred with constant suppression. After additional VT, JB developed stable sensorimotor fusion and random dot stereopsis in free-space with neutralizing prism. A fourth surgery was then performed resulting in esophoria at all distances with good sensory fusion.

Results 

Twenty-one months postoperatively, JB remains nonstrabismic with good sensory fusion.

Conclusions 

Clinicians should understand the roles and limitations of available treatment options. Surgery reduces the magnitude of the deviation, whereas optometric VT provides the unique role of establishing normal sensory processing.