Case Series: Neuroplasticity and Vision Therapy in Adults with Unilateral Small-Angle Esotropia

Introduction Eyecare providers may hesitate to offer treatment to adults with long-standing constant strabismus, assuming that binocularity will be unobtainable. Adult patients may present with personal goals or symptoms that require treatment for their strabismus to restore binocularity. We report three cases of adults with unilateral small-angle esotropia who achieved random dot stereopsis after optometric vision therapy. Case Reports Case one: A 33-year-old man’s goal was to improve vision in his left eye and to appreciate virtual reality. He presented with a constant left esotropia and amblyopia with normal correspondence and no random dot stereopsis. After spectacle correction with vertical prism, vision therapy, and 2 hours of daily patching, he was able to appreciate random dot stereopsis and visual acuity of 20/25 in his left eye. Case two: A 25-year-old woman’s goal was to improve vision in her left eye and establish binocularity because she experienced blur while performing slit lamp examination as a result of her eyes “alternating fixation.” She presented with a constant left esotropia, amblyopia, eccentric fixation, anomalous correspondence, and no random dot stereopsis. After vision therapy, she was able to appreciate random dot stereopsis and visual acuity of 20/20-1 in her left eye. Case three: A 25-year-old woman’s goal was to reduce headache symptoms and establish binocularity. She presented with an intermittent left esotropia with variable left hypotropia, anomalous correspondence, and no random dot stereopsis. After vision therapy, she was able to appreciate random dot stereopsis. Conclusion Although treatment of adult strabismus can be challenging, adults with goals related to binocularity can be successfully treated. These three cases highlight successful vision therapy in motivated adult patients with a goal of binocular vision.