Focus Effort & Eye Crossing
Focus Effort & Eye Crossing
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There are many types of eye crossing in children, however, one of the most common is related to the ability of the far-sighted children to focus at near.  Children with far-sightedness have more difficulty seeing objects up close than in the distance and thus require more effort to focus on objects at near.  The ability to focus on a near object also requires that the eyes turn inward to remain focused on the object. Since eye crossing and focus effort are linked together, children can develop crossed eyes when they are using too much effort to focus on objects of interest.

To see better and reduce the effort of focusing, children with a large amount of far-sightedness and eye crossing will require glasses. As the glasses reduce the amount of effort the child needs to focus on objects it also reduces the amount of eye crossing.  This condition is called accommodative esotropia.

Some children may have additional crossing only at near and can benefit from bifocals.  This provides extra focusing help at near.  If these measures do not work the child may require surgery to realign the eyes.

What if glasses straighten the child’s eyes?

The child whose eyes are held straight by glasses will be followed closely to assure that proper visual development is occurring.   As the child grows older it is possible to eventually wean them out of the glasses once visual development is completed.  Children whose eye alignment improves, but is not satisfactory may need surgery in addition to glasses.

Parents of children with this condition, often notice that the eyes continue to cross when the glasses are removed.  Crossing of the eyes upon removal of the glasses suggests only that the glasses are helping and emphasizes the need to keep glasses on the child at all times.  This crossing may continue until the child either outgrows the farsightedness or readjusts the relationship between focus effort and convergence. Most children whose crossed eyes are straight with glasses begin to maintain good alignment without glasses at about eight or nine years old.  The child with significant farsightedness or other significant optical problems may never be able to maintain good eye alignment without glasses or contacts.

What if glasses do not straighten the eyes?

When glasses completely realign the eyes and equal vision is achieved nothing further is required.  However, when the glasses do not completely realign a child’s eyes, surgery may be required.  Strabismus, like so many other conditions, requires an individualized treatment plan.  Treatment goals, briefly stated are to make your child see well with each eye individually, to make the eyes as straight as possible so that they can function as a pair, and to improve appearance. Dr. Dorfman and Dr. Cardone try to reach these goals by the safest, fastest, most effective means. Surgery is always held as the last resort by our physicians.

Special thanks to Pediatric Ophthalmology Consultants for providing the original Focus Effort and Its Relationship to Crossing of the Eye.

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