In the 50s and 60s of the last century, orthoptic treatment was developed, which has long been considered an alternative or complement to surgical treatment for strabismus. The purpose of orthoptic treatment that can be done on a device called a synoptophore or more precisely, a major amblyoscope, is to stimulate the presence of binocular vision and to strengthen the ability to fuse the two images provided by the eyes to the brain. As neuroscience has progressed and multiple randomized studies have been performed, the importance of orthoptic exercises has greatly decreased considering that their effectiveness in pediatric strabismus is not only low but can even lead to diplopia, namely double vision. Their short- or long-term effectiveness could not be demonstrated in other types of strabismus either.

As the surgery progressed and clear strabismus correction algorithms were obtained, it was concluded that the essential basis for obtaining high-performance binocular vision in strabismus acquired after the age of two years is a very good alignment of the two eyes, that is, a perfect alignment or within the limit of 8 prismatic dioptres (PD), the equivalent of 4⁰ of synoptophore and the absence of amblyopia. At a deviation of more than 8 PD, unfortunately, it is not possible to correctly overlap in the brain the two images, which is why any deviation above 8-10 PD requires surgery or botulinum toxin. Orthoptic exercises have lost their importance because no study has been able to prove their effectiveness even though they have been used for decades in the treatment of strabismus.

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Present day

Currently, there is only one situation in which it is clear that some cases respond effectively, namely the convergence insufficiency.

Convergence insufficiency is the inability to bring the two eyes close enough and effortlessly in order to maintain a single image when we look closely, that is, we read, write, work on the computer, look at the smartphone screen or work on something meticulous.

The importance of a correct diagnosis

There are many patients with this condition and it often goes undiagnosed because the general ophthalmologist does not test the convergence ability.

Convergence insufficiency may or may not be accompanied by a small divergent strabismus and is manifested by headaches, blurred vision, inability to focus and not infrequently, the doubling of the image up close.


These patients, once diagnosed can be treated with prismatic lenses and have a good recommendation for orthoptic exercises that stimulate the muscles that deal with convergence, namely convergence exercises. They can be performed either on a device called synoptophore, or at home, systematically using small objects that are repeatedly followed and brought close to the eyes, or on the computer in the form of Home Therapy exercises for convergence and increase of the fusional amplitude. Oftapro was the first clinic in Romania where computer exercises were accessible to patients since the 2000s.

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When the exercises fail or their effect is very short, if the convergence insufficiency is severe and recurrent, patients receive a surgical indication.

In recent years, we use orthoptic exercises only in specific situations and to the extent that it is not necessary for the patient to travel frequently to our premises. However, although in most advanced countries synoptophore exercises are only used in the case of convergence insufficiency, in Romania, in some centres, they continue to be used as a universal panacea for all types of strabismus.