Rehabilitation Journey-Vision Recovery in Acquired Strabismus Following Post-Traumatic Retinal Detachment

Abstract

Background: This case report examines the rehabilitation of a 21-year-old male with acquired strabismic amblyopia and permanent retinal alterations following childhood trauma and retinal detachment surgery, a scenario rarely documented in ophthalmic literature. The patient’s complex presentation-marked by severe vision loss, constant exotropia, and suppression-highlights the challenges of restoring functional vision in post-traumatic cases with structural damage.

Case Presentation: Initial evaluation revealed right-eye visual acuity of 2/60, exotropia of 45 prism diopters, and absent stereopsis, alongside a macular hole and peripheral vision loss (VFI: 66%). A structured, three-phase vision therapy protocol was implemented: 1) Monocular therapy (foveal tagging, Ambi-iNET, SVI Rotator, MIT-2) to stabilize fixation and enhance oculomotor control; 2) Anti-suppression training (MFBF, Red-Blue Binocular Reading, Brock string) to promote binocular integration; and 3) Binocular vergence therapy (HoloLens VTS4, Tranaglyph cards, Syntonics) to refine sensory and motor fusion.

Results: After 116 in-office sessions, visual acuity improved to 6/18, exotropia reduced to 6–8 prism diopters, and stereopsis emerged at 200 seconds of arc. Oculomotor metrics via HoloLens VTS4 demonstrated 91% saccadic and 94% pursuit accuracy, while NPC improved to 14/17 cm. Functional gains included enhanced comfort during computer use and newfound ability to perceive 3D media.

Conclusion: This case challenges conventional prognostic assumptions by demonstrating significant functional recovery despite irreversible retinal damage. The success of the multimodal approach-integrating traditional techniques with immersive technologies-underscores the potential of tailored vision therapy to restore binocularity and quality of life in complex post-traumatic cases. These findings advocate for expanded research into structured rehabilitation protocols for patients with similar structural and functional deficits.