Intermittent exophoria and double vision

[ctecha]

What is the treatment for intermittent exophoria or just the term "exophoria" where the eyes prefer to be positioned outward but the eye muscles can use appropriate convergence to keep them inward? I read on this article from another site:

Exophoria

This is a condition where the eyes prefer to be positioned outward, but the eye muscles successfully overcome this deficiency. But the effort to achieve this coordination sometimes results in eyestrain and even occasional and intermittent double vision. Exophoria is often easily treated with exercises which stimulate the eye muscles to work properly and the focusing system to "lock" onto the object(s) of regard in the visual field. When the eye muscles fatigue, exophoria can become, intermittently, an exotropia. Doctors often use a stereo vision apparatus, such as polarized vectograms (3-D transparencies) with polarized glasses or red-green 3-D cards with red-green glasses, which allow the user to have constant feedback as to the position of the eyes and whether or not they are working together.

I use magic eye stereogram images right now but should I be using convergence ones or divergence ones? I already went to an opthalmologist and he said that my eyes do prefer to be more straight ahead or sit outward more than inward. He covered one eye while looking at the other and the uncovered eye did drift out a little bit. Any ideas? Thanks for the help

[John C Hagan III, MD, FACS, FAAO]

If you are seeing an orthoptist you are doing all you can with "vision therapy".  In adults the success is very limited. If the condition worsens seeing a strabismus eye MD would make sense.

JCH MD

[milindsmart]

I had an occasional squint from a young age, and had it diagnosed recently, at 24 years of age. I am diagnosed with alternating exophoria. Orthoptic tests also revealed convergence insufficiency and lack of stereopsis. A few days of vision therapy where I had to fuse left and right images brought back stereopsis to some extent. Occasional squint continues, but the tendency to completely ignore one eye is now gone. I may have to visit a squint specialist soon, according to the orthoptist.

Is vision therapy useless for me too? Any non surgical options?

[John C Hagan III, MD, FACS, FAAO]

I am saying That it would likely be much less expensive to consult a strabismus (pediatric) ophthalologist. If you live in the USA find one near you at www.aao.org

Re-read the entire discussion thread. It stands on its own.

JCH MD

[ctecha]

Hi Dr. Hagan,

I was recently diagnosed with exophoria of 20 diopters at near and 6 at distance (snellen chart). Are you saying vision therapy can't help this condition at all? I have moderate to severe symptoms of eye strain.

[John C Hagan III, MD, FACS, FAAO]

In almost all cases you are wasting your money. Vision therapy is a profit center for non-MD optometrists and they ride it for all its worth.

There are no scientific studies that show the vision therapy is useful for anything other than optometrists paying their bills.

I have an exophoria, most do not require any sort of therapy.

JCH MD

[charlie122]

Is there a cure for exophoria? My daughter is having Vision therapy about once a week for the past 3 months, and I do not notice a difference. Am I wasting my money?

[John C Hagan III, MD, FACS, FAAO]

We are very fortunate that JodieJ continues to share her experience and research with our posters.

JCH MD

[JodieJ]

As Dr. Hagan states (above), a phoria is a result of abnormal fusion in the brain, and it is very common and often asymptomatic.  However, even a mild phoria can create significant problems with fusion when you add mild retinal damage (making the images in each eye slightly different in size/shape) and differences in refractive error between the eyes (creating a difference in image size).  Dr. Oyakawa has suggested that you try wearing a contact lens to eliminate the 2+ diopter difference between your eyes due to the buckle.  This should make it easier for your brain to fuse the images from each eye, and it might reduce/eliminate some of your symptoms.

[taurus1203]

I had mild exophoria. The problem sounds not serious will not cause me can't see things. However, it just make my eyes feel tired/pain after reading for 1/2 hr. This really a big impact to my life - Low productivity in work, no entertainment like reading magazine, watching TV.
I heard that some lens with prism power can help to correct this problem. How mature is this technology ? How realistic this kind of lens can solve the exophoria.

[ctecha]

Hi Dr. Hagan,

That's what I was curious about was convergence insufficiency. Very frequently I can see my vision go double while focusing on near objects particularly if I'm tired. It's actually happening right now.. I'll be focusing on the screen or something or the keyboard when I'm typing and then my vision will go double where I see two of everything. I then have to bring the two images back into fusion. The question I had was that I think this is causing more eye aching for me considering my eyes would have to work harder to keep them turned inward if they prefer to be positioned oiutward all the time. Is there anything you can recommend to help this?

[John C Hagan III, MD, FACS, FAAO]

Intermittent exophoria is NOT a clinical diagnosis. Intermittent exotrophia is the correct term. It is not an eye muscle problem but rather a result of abnormal vision fusion in the brain. Now esophoria is very common and often asymptomatic. I am an eye surgeon but I have a small to medium exophoria. It turns into an exotrophia rarely if I am extremely fatigued.

Eye exercises as used by many optometrists as a profit center have not been show to be helpful except for convergence insufficiency. Intermittent exotrophia often requires no treatment, if it degenerates to the point that they eyes are out more than straight then strabisums surgery is usally the answer.

JCH MD