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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
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Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Why would farsightedness be causing esophoria?And, I

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Why would farsightedness be causing esophoria?

And, I understand prisms can compensate for esophoria, but how does one correct the esophoria (eye's desire to point inward when at rest/non-strained); specific eye exercises so eventually straining is no longer needed in order to spread them apart?
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Customer: replied 5 years ago.
Please edit the question and open to all Eye Doctors.

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Hi. I'm online and happy to answer your question today. I see that you have been waiting patiently for a response.
Esophoria, being intermittent and controlled by fusional mechanisms so that the eyes remain properly aligned under normal binocular viewing conditions, requires no treatment or therapy. It is a good idea, however, to make sure that you are wearing your correct glasses Rx if this is necessary.
Farsightedness does not cause esophoria.
On the internet you can find many sites offering therapy, pencil push ups etc to "treat" this condition. In my opinion, they are all a scam.
Does this make sense to you?
It was a pleasure to assist you with your question. Please let me know if I can do anything else to help you in the future. Positive Feedback and/or Bonus is welcomed and appreciated.
Let me know if there is anything else you would like to discuss pertaining to this issue.
Customer: replied 5 years ago.
My question was how do I correct my eye's desire to point inward when at rest (esophoria) so I don't have to strain and get headaches from spreading them apart?
Customer: replied 5 years ago.
your answer was blank.
sorry about that.....must be gremlins in the system again ;)
Esophoria does not need treatment and I do not believe that it would be contributing to your headaches.
Customer: replied 5 years ago.
Please elaborate. Am I supposed to go around seeing double?
(even if the pain is strictly from straining to gain focus, and not from fighting the esophoria; the esophoria still exists)
Although this may seem strange, pediatric ophthalmologists are the experts on esophoria/esotropia and crossed eyes.
I think you would be well served to consult with a pediatric eye doctor. Just remember, while you are waiting, as an adult you don't get to play with all the neat toys :-)
It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you at no additional charge :-)
Customer: replied 5 years ago.
I already saw a pediatric ophthalmologist who specialized in esophoria/esotropia.
I'm here to get an answer from you.
If you don't feel you're a good fit, that's ok, just open my question back up to all.
My pleasure. I wish you the very best and thanks for giving me an opportunity to try to assist you.

Hello and thanks for your question. Maybe I can elaborate a bit on the accurate information Dr. Rick already provided you.

It sounds like you're interested in knowing how to completely rid yourself of the problem of esophoria/tropia and not just deal with its consequences (prisms).

Ultimately, the problem lies in the brain and, consequently, cannot be completely eradicated. Many patients go on to have surgery to realign the eye muscles. Of those who do, most go on to be quite happy and not have problems again, though some can see the esophoria/tropia return and need either prisms again or surgery to realign the eyes again.

In the end, however, because it's an innate tendency of the brain, there's no way to make it completely go away.

Does that make sense?

Customer: replied 5 years ago.
I understand that, thank you.
Is it possible they're pointing inward as a reflex to synchronize with the fact the ciliary muscles are tensing into a state of over-accommodation?

If esophoria is a brain controlled action, then couldn't it be controlled with conscious effort and practice?
that reflex pointing in as part of excessive accommodation could happen, but not in someone your age, just a child.
It is logical to think that this could be consciously controlled by the brain, but in actuality we have very little faculties about our bodies that we can consciously control. Unfortunately esophiria is usually not one of them.
Customer: replied 5 years ago.
Is there a way to test to see if mine is due to that reflex usually seen only in children?

So the fact that I can switch at will between single and double vision doesn't mean I can train it to always be single?
There's no need to test you to see if you have the type seen in children. By virtue of your age and therefore your relatively decreased ability to accommodate compared to kids, yours is different from that.
Ostensibly, your ability to switch from single to double may signal the ability to train your brain how to hold control over it, but if there's a way to do that, I've not come across that in all of my training and experience.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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Customer: replied 5 years ago.
I don't see how a decreased ability to accommodate due to age dictates there must be a breakdown or absence of synchronizing relationship between the accommodative and convergence systems. I would expect this coordination to exist throughout life.

Accommodation and convergence are intimately tied in reflex arcs, one in particular which is called the near reflex. When you look at a near object, three things happen simultaneously on reflex: accommodation, convergence, and miosis (pupil constriction). Children who have esotropia can have a completely accommodative esotropia (meaning their eyes turn in because they are trying to overcome a moderate to severe amount of hyperopia that is not corrected by glasses), a partially accommodative esotropia, or a non-accommodative esotropia. Those with non-accommodative esotropias have some problem within their brain that is not tied to a significant need for glasses (in other words, is not caused by accommodative strain) that still causes their eyes to turn in. For those people we don't know why this is the way it is.

I suspect that you are this way as well. The accommodative and convergence systems do still coordinate in this way throughout life, but your ability to accommodate (because of stiffening and hardening of your natural, crystalline lens) diminishes significantly as you age, ultimately causing presbyopia. But the coordination and reflex itself does not diminish, only the ability of the lens to appropriately respond to the accommodative effort, as it did when you were younger.

I think you have a non-accommodative esotropia, or an esotropia that is not caused by significant hyperopia. Presbyopia is not known to cause esotropia.