A Treatise on Re-Defining Successin Optometric Vision Therapy forStrabismus Based on a Case Seriesof 75 Patients

In the mid nineteenth century, the father of modern ophthalmology and founder of Archives of Ophthalmology, Albrecht von Graefe, summarized the role of orthoptic training for patients with strabismus: “People are really not worthy of all that trouble.” Neither 100 testimonials of patients treated for strabismus nor a retrospective chart review of adult and school-age patients with strabismus seen in my private practice between 2015 and 2022 support von Graefe’s speculations. Of 140 patients seen with strabismus, 75 both received optometric vision therapy (OVT) and met uniform criteria including age, length of therapy, and documented pre/post therapy findings. Of these 75 patients, 65 (87%) were judged successful. In this article, we address a number of questions, but principally these two: 1) What is the role of optometric vision therapy in the treatment of patients with strabismus? 2) How should we judge success in the treatment of strabismus? The two questions cannot be separated, for each defines the other. A sample of guidelines predicated on the work of such notable experts in strabismus treatment as Jampolsky, Parks, Flom, and others reveals no consensus on what constitutes success in the treatment of patients with strabismus. Rather, there are different success criteria for surgery and vision therapy, making it difficult for the lay public to compare outcomes of prior studies. In this paper, I propose a guideline for a “basic behavioral success” that will work equally well for surgery and therapy, making comparisons between the two approaches easier. Extending my previous publications, I factor in new data from testimonials of patients with strabismus as well as 75 questionnaires completed by the patients in this study. From these, I propose guidelines for Behavioral Quality of Life Questionnaires that can be useful for children as well as adults with strabismus.