Dr. Mozlin’s recent blog post highlighted the importance of a co-management approach to strabismus – cases in which surgery and vision therapy are required. This inspired me to share my own story of a patient who received vision therapy after surgical correction…albeit 8 years later!

When I met WP he was a sweet, 13-year old boy (currently in 7th grade) who had strabismus surgery at the age of 5. At the time, WP’s eye was wandering out (what we call an “exotropia”), and the turn was so large that his parents opted for surgical correction. The surgeon and his parents were very happy about the outcome…. WP’s eyes looked great!

However, many years later, WP did not appear to be reaching his full potential in school. He often complained that his eyes were sore after reading, and that occasionally, he experienced double-vision. At maximum effort, WP was getting C’s. He simply knew something was wrong with his eyes.

When I examined WP, I discovered that he was still an “intermittent exotrope”, which means sometimes his eyes were aligned but sometimes his eyes would drift out. The eye turn was so small that nobody noticed it…not even a few eye doctors!

I explained to his mother that, although WP’s eyes looked straight, he had never learned to integrate the two eyes together. He was not fully binocular. He was shifting back and forth in an intermediate state – one in which he sometimes used both eyes together but often used only one eye at a time. And this binocular instability was causing him great distress.  “The good news,” I said, “is that it’s not too late to help!” We enrolled WP in an intensive vision therapy program that focused on binocular integration. Fast forward six months later, and WP is a new man. Not only is he now fully binocular, but his symptoms have completely resolved. His eyes are no longer sore, his reading has improved, and he is getting straight A’s in school. WP is finally reaching his full potential.

As WP emphatically states, “Everything is easier now!”

This was a very successful case. It demonstrates the tremendous impact we can have on patients if we take a co-management approach to strabismus. Even though his eyes appeared straight after the surgery, he needed vision therapy to function binocularly. The vision therapy made WP fully binocular.

Read more about strabismus here and here.  And don’t miss this one!

This blog post was written by our newest author, Dr. Michael Montenare.  Dr. Montenare graduated from SUNY College of Optometry in 2012 and completed his residency training in Vision Therapy and Rehabilitation through the Southern College of Optometry. He is now an associate director of the Vision and Learning Center at Family Eyecare Associates, PC in Fair Lawn, New Jersey. Before entering optometry, Dr. Montenare taught high school English for several years, and has always been interested in the visual dynamics of reading and learning. He specializes in learning-related vision problems, Children with Special Needs, and mild traumatic brain injury.

Welcome Dr. Montenare!

Photo credit: By Rod Waddington from Kergunyah, Australia (Boy in Jimma, Ethiopia) [CC-BY-SA-2.0 (, via Wikimedia Commons