Don't Take It Lightly, Early Detection Helps Maintain Vision Function

JAKARTA - Cross-eyed eyes or strabismus are often considered a matter of appearance. In fact, the condition when the position of the two eyes is not parallel can affect visual function, including binocular vision and depth perception. In children, strabismus can increase the risk of amblyopia or lazy eye if not handled properly.

In conjunction with World Strabismus Day (World Strabismus Day) which is celebrated every August 10, attention to the detection and treatment of strabismus is again important. Early examination can help find out the cause of squint and determine the appropriate treatment, especially when the child's vision system is still in the development stage.

Strabismus occurs when one eye sees an object, while the other eye deviates or deviates. The shift can lead to the inside, outside, up, and down.

This condition can interfere with the coordination of the two eyes and the ability to see binocularly. In children, this disorder can affect the development of visual function and increase the risk of amblyopia.

"Strabismus has different causes, patterns, and treatment needs for each patient. Therefore, a complete examination, support from a Consultant Pediatric Ophthalmology & Strabismus Specialist Eye Doctor, as well as the appropriate and sustainable choice of therapy are needed," said Dr. Refero Agustiawan, SpM(K), Director of JEC Eye Hospital @Menteng in Menteng, Central Jakarta, Monday, August 10, 2026.

"In addition to improving visual function, strabismus can also have a psychosocial impact. In children, this condition can lower self-confidence and increase the risk of bullying, while in adults it can affect social interactions, self-confidence, and opportunities in the professional environment. Through the Strabismus Eye Operation Center, both children and adult patients can get the right treatment, ranging from non-surgical therapy to surgery based on medical indications," he added.

The treatment of strabismus cannot be generalized. Doctors need to consider a number of factors, including the cause, the patient's age, the direction and magnitude of the deviation of the eyes, visual acuity, refractive abnormalities, the presence of amblyopia, binocular vision function, and accompanying health conditions.

Based on the results of the examination, treatment can be in the form of the use of glasses, therapy for amblyopia, certain vision exercises, to eye muscle surgery if there are medical indications.

The success of therapy is also not only judged by changes in eye position. Improvement of visual function and coordination of both eyes, reduction of double vision, and the patient's ability to carry out daily activities are important parts of the evaluation.

Prof. Dr. Tjahjono D. Gondhowiardjo, SpM(K), PhD, Senior Director of Development and Education of JEC Eye Hospitals and Clinics, emphasized that patient trust is built through medical staff competence, accuracy of diagnosis, relevant technology, and clear communication.

"In the treatment of strabismus, each patient can have different causes, vision conditions, and therapy needs. Therefore, patients and families not only need examinations or actions, but also a sense of security and confidence that the medical decisions made are truly in accordance with the needs. This is the principle that JEC Eye Hospitals and Clinics continue to maintain through integrated services, supported by sub-specialized medical personnel, and oriented towards the patient's vision function and quality of life," said Prof. Tjahjono.

As part of efforts to strengthen the treatment of strabismus, JEC Eye Hospital @ Menteng presents the Strabismus Operation Center, a special service for children and adults.

The services include diagnostic examinations, correction of refractive disorders, amblyopia therapy and vision exercises, to eye muscle surgery based on the patient's diagnosis and clinical needs.

The range of services available includes visual acuity examination, refractive abnormalities, position and movement of the eyeball, binocular vision function, and other eye conditions. Stereopsis and coordination of both eyes can also be performed using tools such as Synoptophore, TNO, and Fly Test according to clinical needs.

Certain patients may benefit from corrective eyewear, including special lenses or prisms to help focus, reduce deviation, or overcome double vision. Amblyopia therapy can be done through patching or closing the stronger eye for a measured duration to give the weaker eye stimulation.

Vision training can also be given based on medical indications to help coordinate the two eyes. Meanwhile, eye muscle surgery is considered if non-surgical therapy has not provided adequate results or there is a clear medical need.

In addition to providing an integrated treatment option, this service center helps patients and families understand the condition, the purpose of therapy, and medical considerations before deciding on actions.

"The decision to operate is not made only to improve appearance, but further to improve the overall function of the eye, such as helping to overcome single binocular vision," added Dr. Gusti Suardana, Sp.M (K), Ophthalmologist Consultant Pediatric Ophthalmology & Strabismus, and Head of Pediatric Ophthalmology & Strabismus Service JEC Eye Hospitals and Clinics.

"Therefore, before taking action, we need to assess the pattern and magnitude of deviation, the function of both eyes, age, causes, and the patient's health condition. If surgery is needed, the planning is arranged individually (according to the needs of each patient) and accompanied by continuous monitoring after the action," he continued.

Strabismus can be distinguished based on the direction of eye shift. Esotropia occurs when the eyes shift inward or towards the nose, while exotropia occurs when the eyes shift outward. Eye shift upwards is called hypertropia, while downward shift is called hypotropia.

In addition to based on the direction of deviation, strabismus can also be recognized based on the pattern of its appearance, including:

- Manifest or real strabismus, that is, the misalignment of the eyes that is clearly visible and can appear constantly.

- Latent or hidden strabismus, which is the tendency of the eyes to shift (deviate) which is usually not visible in everyday conditions and is only detected through certain examinations.

- Intermittent or intermittent strabismus, i.e. crossed eyes that only appear at certain times, for example when the child is tired, sleepy, daydreaming, sick, or losing focus.

- Alternating or alternating strabismus, that is, an imbalance that can switch between the right and left eye.

Public understanding of strabismus is also still influenced by various myths. Some consider strabismus to be merely a cosmetic problem or a condition that can be left alone. In fact, strabismus is a medical condition that needs to be examined to find out the causes, its impact on visual function, and the options for handling it.

Early detection can be done by paying attention to the symmetry of the light reflex on the cornea of both eyes, the position of the eyeball, and changes in the direction of vision that can be seen in photos or video recordings.

However, the findings still need to be confirmed through a thorough eye examination. The examination is needed to assess the position of the eyes, visual acuity, binocular vision function, and the risk of amblyopia.

Strabismus in children is not always easy to recognize. In certain conditions, the position of the eyes can look normal when the child is focused, but it seems to shift when the child is tired or sleepy.

DR. dr. Lely Retno Wulandari, SpM(K), as Deputy KETUA INAPOSS (Indonesian Pediatric Ophthalmology and Strabismus Society) as well as Consultant Pediatric Ophthalmology & Strabismus Specialist Ophthalmologist JEC Eye Hospitals and Clinics, explained that hidden strabismus or latent strabismus is not always easy to recognize. Eye position can look normal when the child focuses, then it looks shifted when tired or looking at photos and video footage.

"In babies as young as three to four months, the eyes sometimes seem not to be fully coordinated because the vision system is still developing. However, if the misalignment persists after the age of four months, strabismus is generally no longer considered a normal condition and requires examination to determine the cause," explained dr. Lely.

"In the field, there are still children with crossed eyes who are late in getting an examination because the condition is often considered only a matter of appearance or can be postponed. In fact, strabismus can affect visual quality and increase the risk of amblyopia or lazy eye, especially during the development of children's vision. Proper handling is expected to not only help improve visual function, but also support children's quality of life through better eye appearance so that children can grow and be more active with confidence," he continued.

The examination becomes even more important when parents notice that the position of the two eyes is not permanently aligned, the eyes seem to shift in certain conditions, or there are repeated changes in the photo and.

Strabismus is influenced by various factors. Family history, premature birth, low birth weight, uncorrected refractive abnormalities, and differences in visual acuity between the two eyes are some of the factors that may be related to the condition.

In some patients, strabismus can also be associated with disorders of the brain or the nerves that move the eyes. Neurological conditions, trauma, diabetes, hypertension, and certain systemic diseases can also cause strabismus, especially those that appear in adulthood.