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—In response to Dr Fleming's letter about pediatric ophthalmologists, I have never been a pediatric ophthalmologist, but I have been a strabismologist for nearly 30 years. The oldest patients I have operated on for DVD have been between 40 and 50 years old. Patients with conditions physicians report cannot be cured surgically become discouraged and stop consulting ophthalmologists (eg, jawwinking syndrome, Duane's syndrome, and double elevator muscle paralysis). Then, when these patients discover someone is correcting the conditions, they try again. Although double dissociated vertical deviation occurs in 90% of cases with congenital esotropia, only about 5% are severe enough to warrant surgical intervention. These severe cases do not improve by the mere passage of time.
Knapp P. Dissociated Vertical Deviation-Reply. Arch Ophthalmol. 1980;98(11):2083-2084. doi:10.1001/archopht.1980.01020040935034