Strabismus - Surgery or Eye Therapy

My son is 4 years old.  He has had strabismus since birth. Vertical and horizontal misalignment in both eyes.  He has good vision in both eyes though, and his eyes usually only cross when he is tired.  We have seen many doctors and they all recommend surgery.  I have tried to inform myself by doing research on the computer and I am seeing many good reports about eye therapy.  We went to a clinic here (Toronto, Canada) and the only vision therapy they offered was for exotropia (outward turn), but my son has esotropia (inward and upward turn).  There is no therapy at all offered before or after surgery, and he is going to need more than one surgery.  My concern is that he does not seem to have any 'real' vision problems right now and that the surgery will be only cosmetic.  I am afraid of trading vision for looks and I am afraid that if we have surgery, we will not be able to do vision therapy later on.  Should we take our son to the United States for vision therapy before committing to surgery here?  Has anyone on this forum had this surgery or eye therapy and has it been helpful?

[Ray T Oyakawa, MD]

For the sake of your son do it NOW.  Vision therapy does not work.  

Dr. O.

[JodieJ]

Vision therapy is controversial.  The vision therapy literature (written by vision therapy practioners) reports that vision therapy works best for exotropia.  It is reported to work much less well for esotropia, and it is ineffective for vertical deviations.

Sometimes cosmetic issues can make a big difference in someone's self-esteem.  If it were my son, I'd opt for the surgery.  Why not schedule a consultation with the surgeon to get his/her opinion about what the surgery would involve and why s/he thinks it would benefit your son.