More on Strabismus as a Head-to-Toe Adaptation

We blogged in April on Strabismus as a Head-to-Toe problem and now, courtesy of our colleague WC Maples and his international research connections, comes word via Anna Przekoracka-Krawczyk of new work adding to the scientific underpinnings of strabismus as a whole body issue.


Fortunately this research is in open access format, and I’d encourage you to read and share it with as many patients and colleagues as possible.  The journal article from collaborative research in Italy is Walking Strategies in Subjects with Congenital or Early Onset Strabismus.


In short, the authors documented that patients with esotropia have shorter step widths during gait, consistent with constricted binocular visual fields as reported in the literature.  They noted previous reports that strabismus surgery for esotropia can result in a wider binocular visual field.  Optometric authors such as Chisholm in the UK have recognized that the Esterman Binocular Visual Field Plot is more indicative of dynamic performance in activities such as driving, and undoubtedly this is a standardized clinical measure that will become more useful not only in the management of glaucoma but in strabismus as well.  Conversely, the authors in this study report that patients with exotropia have wider step widths during gait, consistent with expanded binocular visual fields.


The authors conclude their paper by noting that their results about walking strategies of patients with congenital or early onset esotropia or exotropia suggest the application of integrated rehabilitation therapies focused not only on gait training, but also on visual field training.  Although the authors appear to be oblivious that optometric vision therapy has incorporated these strategies, it would be prudent to embrace this “novel” approach.  In the spirit of the World Cup, Viva Italia!


By the way, take a look at some of these interesting references cited by the authors:


Gaertner C, Creux C, Espinasse-Berrod MA, Orssaud C, Dufier JL, Kapoula Z. Postural control in nonamblyopic children with early-onset strabismus. Invest Ophthalmol Vis Sci (2013) 54:529-536.

Gaertner C, Creux C, Espinasse-Berrod MA, Orssaud C, Dufier JL, Kapoula Z. Benefit of bi-ocular visual stimulation for postural control in children with strabismus. PLoS One (2013) 8(4):e60341.

Graci V, Elliott DB, Buckley JG. Peripheral visual cues affect minimum-foot-clearance during overground locomotion. Gait Posture (2009) 30:370-4.

Graci V, Elliott DB, Buckley JG. Utility of peripheral visual cues in planning and controlling adaptive gait. Optom Vis Sci (2010) 87:21-7.

Hallemans A and Aerts P. Effects of visual deprivation on intra-limb coordination during walking in children and adults. Exp Brain Res (2009) 198:95-106.

Hallemans A, Beccu S, Van Loock K, Ortibus E, Truijen S, Aerts P. Visual deprivation leads to gait adaptations that are age- and context-specific: I. Step-time parameters. Gait Posture (2009) 30:55- 59.

Hallemans A, Beccu S, Van Loock K, Ortibus E, Truijen S, Aerts P. Visual deprivation leads to gait adaptations that are age- and context-specific: II. Kinematic parameters. Gait Posture (2009) 30:307-311.

Hallemans A, Ortibus E, Meire F, Aerts P. Low vision affects dynamic stability of gait. Gait Posture (2010) 32:547-551.

Konczak J. Effects of optic flow on the kinematics of human gait: a comparison of young and older adults. J Mot Behav (1994) 26: 225-236.

Kushner BJ. Binocular Field Expansion in Adults After Surgery for Esotropia. Arch Ophthalmol (1994) 112:639-643.

Kushner BJ. Binocular field expansion in adults after surgery for esotropia. Arch Ophthalmol (1994) 112: 639-643.

Legrand A, Quoc EB, Vacher SW, Ribot J, Lebas N, Milleret C, Bucci MP. Postural control in children with strabismus: effect of eye surgery. Neurosci Lett (2011) 501:96-101.

Lions C, Bui-Quoc E, Bucci MP. Postural control in strabismic children versus non strabismic age- matched children. Graefes Arch Clin Exp Ophthalmol. (2013) 251(9): 2219-25.

Matsuo T, Narita A, Senda M, Hasebe S, Ohtsuki H. Body sway increases immediately after strabismus surgery. Acta Med Okayama (2006) 60: 13-24.

Matsuo T, Yabuki A, Hasebe K, Shira YH, Imai S, Ohtsuki H. Postural stability changes during the prism adaptation test in patients with intermittent and constant exotropia. Invest Ophthalmol Vis Sci (2010) 51(12): 6341-7.

Matheron E, Le TT, Yang Q, Kapoula Z. Effects of a two-diopter vertical prism on posture. Neurosci Lett (2007) 423(3): 236-40.

Odenrick P, Sandstedt P, Lennerstrand G. Postural sway and gait of children with convergent strabismus. Dev Med Child Neurol (1984) 26(4): 495-9.

Przekoracka-Krawczyk A, Nawrot P, Czaiska M, Michalak KP. Impaired body balance control in adults with strabismus. Vision Res. (2014) 98: 35-45.

Reynolds RF, Day BL. Visual guidance of the human foot during a step. J Physiol (2005) 569: 677- 684.

Iosa M, Fusco A, Morone G, Paolucci S. Effects of Visual Deprivation on Gait Dynamic Stability. ScientificWorldJournal (2012) 2012:974560.

Wortham E, Greenwald M. Expanded Binocular Peripheral Visual Fields Following Surgery for Esotropia. J Pediatr Ophthalmol Strabismus (1989) 26: 109-112.

Wortham E, Greenwald MJ. Expanded binocular peripheral visual fields following surgery for esotropia. J Pediatr Ophthalmol Strabismus (1989) 26:109-112.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s