Vision Therapy After Strabismus Surgery: The Good, The Bad and The Ugly

Strabismus surgery is a great option to align your eyes, but are you worried that you will fall into the large category of people whose eyes drift back out of place?

I know that that was one of my main concerns!

I knew that in order for my brain to keep my eyes straight after surgery, it was going to need to know how to use them both together, which is why I opted for vision therapy. 

To learn more about vision therapy before surgery, the actual surgery and resources that I offer, click the links below:

What can you expect from vision therapy after surgery?    

It is common for strabismus patients to do vision therapy, followed by strabismus surgery, followed by more therapy to gain full binocular vision.  

The surgery initially feels like a major setback, but give it time because eventually you will see quicker and more lasting results.

Here are a few things you can expect in post-surgery therapy:

  • It will be difficult to do basic eye movements for 2-3 months and your eyes might feel jumpy.
  • If you have changed from exotropia to esotropia, the exercises will be harder.
  • Once regained, the depth and stereo will be even better!
  • The therapy will help take your eyes to perfect alignment.
  • If your eyes are more straight you will be able to relax much more easily when doing fusion exercises.
  • Even though you will probably have regression at first, the progress will happen much more quickly than the first time.
  • You will question your decision and may feel like you’ve made a big mistake.

If you are considering vision therapy or surgery or the combination, you should definitely schedule a consult with me.  CLICK HERE to learn more.

I can help you discover your perfect path and  you will find answers for your specific situation. 

For specifics on what my experience has been since having strabismus surgery, read on.

Phase 1: What Have I Done??!?!? 

August 2020-November 2020

For the first few months of therapy after surgery I exerpienced extreme regression!  I felt like I had lost every gain that I had made during the therapy I completed before surgery.  CLICK HERE for more info about round 1.

I was unable to use both eyes together unless it was within a few inches of my face.  

My right eye felt jumpy and I was terrified that I had made a huge mistake.

Over the first 10-12 weeks I slowly regained vision skills.

At 2 weeks out from surgery I was measuring at 17 diopters of esotropia in the distance and 6-8 at near.  I couldn’t see any real depth and was suppressing quite a bit.  Dr. Dan focused on peripheral and building back with basic fusion exercises.

At 7 weeks out I upgraded my VR to the Oculus Quest and started Vivid Vision. It was exhausting, but effective.  At this point I started seeing improvements with my depth perception and stereo started popping in in real life again.

After 11 weeks I felt like the in-office therapy was getting back to the point I was at before surgery.  I even saw the stereo fly with depth for the first time.  

Things weren’t perfect and I knew there was a long way to go, but I was seeing flickers and the progress was happening rapidly.  What took me 6 months to achieve when I first started therapy only took a few weeks to regain after surgery.

Phase 2: Building Skills And Decreasing Prism 

November 2020-June 2021

After I saw the stereo fly, I felt a renewed determination and I was full of hope.

I had been eating a nutritarian diet for 3 weeks and I knew that the food was making a huge difference.

If you want to download my free “Eating for Stereopsis” guide and see how I eat, CLICK HERE.

For the next several months I slowly progressed, but it wasn’t fast.  I was dealing with very unhealthy kids that needed my attention, but I just kept moving forward, even if it was slow.  I missed several appointments and if it hadn’t been for my home Vivid Vision subscription, I know I would have regressed!

I started noticing huge improvements while wearing prism glasses with binasal occlusion.  I saw progress in my vision therapy activities and started seeing more and more stereo in real life.

By March of 2021 I had purchased an entire 3D TV set up and was able to see a huge jump in my progress with therapy.  I try to watch a 3D movie at least once per week.

I started the year with a 10 diopter prism over my right eye and in April and May I kept progressing and Dr. Dan was able to decrease the prism to 8, then 6, then 4.  It was a very exciting time and the progress was measurable and real.

In May I tried taking medicine for ADHD and it did not help at all.  I was hoping that it would help me stay focused longer on vision therapy and that I would be able to control my eyes better.  It mostly just made me really angry and I couldn’t sleep.

When I look back at this time and review my notes, it is crystal clear to me that when I was stressed and busy, I would regress a few weeks later and when I refocused on eating healthy and being consistent with my home exercises, the weeks that followed were full of success.

Phase 3: A Break and Regression

June 2021-September 2021

I decided to take a break over the summer.  Instead of weekly visits, I did monthly visits.  I wanted to focus on being present with my family and I just needed a break.

I still tried to do home exercises and virtual reality at least 3-4 days each week and I wore my prism glasses consistently.

I hit a dead halt in decreasing the prism in my glasses, but I also started experiencing more 3D in real life throughout the summer.

By the time school started for my kids and I went back to weekly therapy,  I noticed that I was starting to suppress my right eye again.

I felt like my right eye was dying just like it had felt years earlier.  It was very discouraging.

I also started getting pretty bad double vision in the distance.

Phase 4: Back In The Game

September 2021-February 2022

With the huge regression I experienced over summer, I felt pretty depressed, and was ready to give up on vision therapy for good.  I felt pretty lost and shared that with my OD at a progress visit.  My numbers were okay, but kept fluctuating with hypertropia mixed in.

Dr. Dan and I committed to both reassessing and start looking at things from a different angle.  He re-watched all of Dr. David Cook’s lectures, I started studying Dr Cook and The Bates Method and we decided to give it one last try before giving up.

I focused on finding small things I could change in my daily life that might add up to big successes.

I realized that I had completely gone off of my healthy eating plan and hadn’t been at all consistent.  I said goodbye to sugar and hello to salad once again and it made a huge difference.

We also realized that the stick on fresnel prism was making it too hard for my right eye to see.  Dr. Dan had me switch it to the other eye, but that was even worse.

By November Dr. Dan prescribed glasses with prism (3 diopters on each side) for me to use instead of a fresnel prism.

A third important change occurred by accident.  I thought I was having heart problems because my heart would start racing for no reason.  It especially bothered me when I’d wake up in the middle of the night and be awake for hours with no reason except that I felt like someone had given me an epinephrin shot.

 I mentioned it at my yearly appointment and she suggested that it was anxiety and that I could try a low dose of Zoloft.  

I was very hesitant because I’ve never considered myself to be depressed or have anxiety, but I decided to give it a try.  

I was amazed.  

Not only did my random mini heart attacks disappear within a few days, I had way more patience with my family and my vision improved tremendously.

I could relax and hold my eyes still and everything started falling into place.

With those three major changes, along with consistent appointments and home exercises, I immediately started seeing improvements.

My right eye came back to life and by December 2021 I wasn’t using my glasses with prism at all.  The double vision was gone, even when I was driving.

In-office appointments focused on open space and peripheral.  we went back to the basics and I didn’t do any computer work for about 2 months (except for VR at home).

My peripheral and sense of space magnified and I have continued improving up until the point I am at now.

Is my vision perfect? 

Nope, not even close.

Is my depth perception improving?


Am I zeroing in on the factors that make the biggest difference in my vision?

1000% yes!

I might opt to graduate from in-office therapy in the next few months and continue the slow and steady progress on my own.  Retraining my brain is taking time, but for now, my eyes are working together most of the time and my eyes are usually straight.

At near, I measure with 0-6 diopters of prism, more and more at the 0 range.  In the distance I’m still at 10-12, but it has definitely improved since having surgery. 

I believe that the therapy is helping the results from my surgery stick.  There are so many factors that influence vision.  The fact that I have anomalous retinal correspondence (ARC) and congenital esotropia complicate everything.  I’m so grateful that I’ve had both therapy and surgery to work together for my good.

One day, I’ll be done, but that day is not today (February 23, 2022).

If you are considering vision therapy or surgery or the combination, you should definitely schedule a consult with me.  CLICK HERE to learn more.

I can help you discover your perfect path and  you will find answers for your specific situation. 

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