In Malaysia we may find some people with a squint eyes or strabismus. What is strabismus or squint eye? In Bahasa Malaysia strabismus or squint is call as mata juling.A person is said to have a squint eye when one of the two eyes is not directing to the same point as the other eye. In other word there is no similar focus point for both eyes. Because there is no similar focus point, the images receive by both of the eyes cannot be superimpose in the brain. Instead of the brain receiving the same images of the same objects and to be superimposed in the brain, the brain is now receiving two images of the different object which cannot be superimpose by the brain. In eyes with squint or strabismus, the brain is receiving two images of the different object which cannot be superimposed. When our brain cannot superimpose the two images view by the two eyes, our brain will take the drastic action of suppressing one of the images. Usually our brain wills supressed the retinal image of the lower quality. Our brain need to have two retinal images of the same object to be superimposed in order to have depth perception. Without two retinal images of the same object being superimpose on top of each other, no depth perception is possible. In other words, a person who has a squint or strabismus will not have a depth perception. A person with a squint may be able to see with a 6/6 vision but without any depth perception. What is the advantage of having a depth perception? With a depth perception a person is able to judge the size of an object more accurately. A driver with no depth perception will not be able to judge how far, he is driving from the car in front of him. A surgeon with no depth perception will not be able to accurately judge how far the tissues are from him. In other words, a person with a squint or strabismus will not have a depth perception and they will not become a good driver, pilot or a surgeon.

We are seeing with our brain and not with our eyes. Our eyes are only the mean upon which the rays of light enter our eyes and reaching to the back of the eyes known as retina. When the light rays touch the retina, the rays will be converted into action potentials (energy waves) which travel via the neurones to the visual cortex of the brain. Our brain will interpret the waves of the action potentials and converted the waves into pictures of three dimensions and with colours .Our brains have the ability to interpret the various waves that reach the visual cortex into pictures in splits of seconds. When the visual cortex is damaged, we will not be able to see although we may have two very beautiful eyes. Our most common causes of blind are not due to the damage of the visual cortex but due to the inability of the light rays to reach the retina due to the opacity in the crystalline lens known as cataract. With simple operation, the opaque crystalline lens or cataract can be removed and the blind men can resume a normal sight. Strabismus or squint will not lead to blindness.it is not related to diseases of the eyes but it is related to the function of the eyes when the eyes are used binocularly. With only one eye one can see the world and one can function normally as other peoples without a squint or strabismus. A person with only one eye can function quite normally as peoples with two eyes. Having two eyes is the same as having two kidneys. A person with only one kidney can function quite normally as a person with two kidneys. Since kidneys are organs to eliminate toxin from the blood, the only different is the kidney of a person with only one kidney will have to work harder than the kidneys of those who have two kidneys. On the other hand, eyes are organs that enable us to see the world and it is an important organ to the body. Allah has given us two eyes. With only one eyes we can see the world but with two eyes we can see the world with stereoscopic vision. A stereoscopic vision means we can see the world in three dimensions. We can see the depth of the things that we see, which we cannot see with only one eye. With stereoscopic vision, we can judge distances and we can have perspective in our vision. With both eyes available to a person, he or she can see the world to be more beautiful than a person with only one eye. On addition to that a person with two eyes is more cosmetically presentable than a person with a squinting eye

A child born with a squint if not treated early will have squint for the rest of his or her lifes. Squint in a laymen term can be defined as both of the eyes have no alignment with each other’s. A car is not aligned when the four tyres of the car are not well aligned. A car with the two tyres either front or the rear tyres are not well aligned will not move forward in the straight direction but will continue to deviate in either direction. The eye which is squinting will not focus on the objects of focus but it will focus on other objects. In other word, one eye is focusing on one object and the other eye is focusing on another object .In normal eyes without squint or strabismus, both eyes will be focusing on the same object of focus at any particular times. In normal eyes without squint at any particular times, the brain is seeing two images of only one object but in squinting eyes, at any particular times, the brain is seeing the images of two different objects. When the brain is seeing two different images, the brain will have difficulty in superimposing the images and the person will have double vision. A person with a symptom of double vision is said to have a squint or strabismus. Whenever a person reported to have a double vision, it indicates that person has acquired a squint or strabismus. Whenever the two eyes are not aligned, our vision will become double. Whenever a person has a double vision often he or she will also has a headache. Whenever one eye is closed the double vision will disappears and headache will also subsides. An acquired squint can be associated with systemic diseases such as diabetic, hypertension. Often when the diabetic or hypertension is treated the squint also disappears.

Some children are born with a squint and this squint is often due to the malformation of one of the six ocular muscles surrounding the eyes. Surgery must be performed to correct the muscles of the eyes before the child attain the age of five or six years old. According to vision scientist, eyes are part of our brain and our brain attains maturity at the age of six. Similarly our eyes attain its maturity at the age of six. Vision scientists call the period before the age of six as the plastic state of the brain and because the brain is in the plastic state, the brain can still be modified or changed to whatever forms we want. After the age of six, our brain is no longer plastic, which means our brain can no longer be modified or changed to the forms that we want. In other words, after the age of six our brain has become hardened. If a child is born with a squint or strabismus is to attain a normal binocular vision, that squint or strabismus of the child must be operated before the age of six. Any squint operation done after the age of six may not enable the child to have a normal binocular vision as those with two normal eyes. Squint operation after the age of six may resolve the squint problem but it does not resolve the binocular vision problem. Cosmetically the child may no longer  having the squint but vision wise the child will not have stereoscopic or binocular vision. In case we want our child with a squint to attain good binocular vision and cosmetically sound, we must make our child to have squint operation before the age of six.

Besides the manifest squint or strabismus, there are also conditions known as latent squint or phoria. Latent squints are the squints that are normally hidden or not visible under normal situation but it becomes manifest under stress conditions. The symptoms of latent squint are often transient blur and headache. Manifest squint can be treated by surgery done by ophthalmologists specialising in squint surgery. Latent squint probably can be treated using eyes exercises, correcting refractive errors or by mild prismatic correction. Squint and latent squint can only be detected and diagnosed by optometrists and ophthalmologists. Opticion are not trained to detect and diagnose these problems of the eyes. While squint surgery can only be done by the ophthalmic surgeons, other treatment of squint eyes can be done by an optometrist. Although there are many ophthalmologists but very few of them are specialising in squint or strabismus surgery.

Dr T S Surendran is one of the few ophthalmologists who are specialising in squint surgery. He is currently working as an ophthalmic surgeon, in the best eye hospital in India, known as Sankara Nethralaya Chennai India. He is the Vice Chairman of Sankara Nethralaya and the President of Strabismological Society of India. He is a well-known figure in Paediatric Ophthalmology in Asian –Pacific region.

Prof Dr Nasoha Saabin
December 2011
Integrative Holistic Wellness Centre