Re: adult strabismus
- From: "David Robins, MD" <trashadd5@xxxxxxxxxxx>
- Date: Thu, 08 Jun 2006 22:10:32 -0700
On 10/11/05 5:42 PM, in article bflok19b98eok44suq5s4hisirqc9rmipj@xxxxxxx,
"Neil Brooks" <Neil0502@xxxxxxxxx> wrote:
"Susan" <snewman@xxxxxxxxxxx> wrote:
My name is Susan, I am 41. I have had strabismus since I was 3. My
eyeglasses and contacts always straightened my lazy eye until I turned
33! I had muscle surgery in 1997. I was happy for awhile, but over
time I began having trouble making eye contact with people again. The
degree to which my left eye crosses is subtle but it was completly
straight for 30 years with my prescription. My prescription by the way
is +5.50 in both eyes with an add on for reading of +1.50. I also have
a strong family history of glaucoma and my pressures are up. I am in
the process of making an appointment with my regular doctor to do a
full work up for the glaucoma. I know I have to consider the glaucoma
problem first, but I don't know what to do about another muscle
surgery. I just recently went back to work after raising my family and
I don't know if the risks of surgery are worth it. I have never had
double vision. Is it likely that I may have double vision after
surgery? What are some of the other side affects related to muscle
surgery? I would love to have my old self confidence back but is it
worth the risk? Somebody Help!!!
[long winded answer. Just back from a bike ride and a little wired!]
Susan-
I'm NOT an eye doctor, but a 41 year old who was born with strabismus
(got ya' beat!) ;-) I've had three alignment surgeries. I've learned
a thing or two along the way ... though little to nothing about
glaucoma.
Does it turn when looking at near objects only, at far objects only,
or both? Do you know whether it turns the same amount no matter which
way you're looking, or whether the amount of turn varies? These are
important questions that a strabismusologist will look at.
At age 41, when you and I are becoming presbyopic (us highly
farsighted people usually get presbyopic earlier than most), you're
losing whatever accommodation you had. This makes me wonder if what
you're seeing is accommodative esotropia (turning of that left eye due
to uncorrected farsightedness). Because you say that your eyeglasses
AND contacts (presuming you wore them separately) kept your eyes
straight, I'm thinking this may be important. Contacts don't have
prism in them, per se, so they have no mechanical ability to
straighten your eyes. If, indeed your eyes were straight with
contacts, its likely that your esotropia is, at least in part,
accommodative.
Was that +5.50 prescription measured with your eyes dilated?? You may
need the eye doctor to do what they call a 'cyloplegic refraction' and
push your eyeglass/contact prescription to "maximum plus." That would
relieve any accommodative component to your eye turn, allowing them to
determine how much, if any, eye turn remains.
You also may want to talk with your strabismus ophthalmologist about
"Prism Adaptive Trials," especially since you've already had a
strabismus surgery. The theory of PAT is that--like farsightedness,
you /may/ have more strabismus than is readily apparent. They put
prism lenses on you, in increasing strengths, over a several week
period, to determine the 'true' amount of esodeviation (eye turn) that
you have. IF it's enough (usually, surgery is indicated at around 12
diopters or more of esodeviation) then it may be worth your while.
Have you considered wearing prisms in eyeglasses /instead of/ surgery?
As to the surgery itself: it's pretty common, as I'm sure you know.
These days, some surgeons are using what's known as "Delayed
Adjustable Suture" technique. I should know. As far as my surgeon
knows, I came up with the idea ;-) This means that--after the
surgery--they leave the sutures dangling from the eyes, allowing the
swelling to subside over a few days. Then, in an office visit, the
surgeon sort of 'fine tunes' the result as he ties off the sutures.
It enhances the surgical result. Is it /likely/ that you'll have
double vision after surgery?? If you have a big deviation now, and
you aren't seeing double /with/ it, then a successful surgery
shouldn't leave you with double vision.
We'd have to understand a little more about the specifics of your
deviation to give much more feedback. I'm hoping that Dr. David
Robbins will jump in here. He's a strabismus ophthalmologist who,
doubtless, knows heaps and heaps more than I ;-)
All the best, Susan ... and ... don't worry too much about the
strabismus. It's pretty fixable ... in several ways.
Neil
Can't add much to what Neil said without an exam with all the particulars.
However, if the angle is noticeable but small WITH GLASSES ON (they will
cross when off, of course), then you might be a candidate for BOTOX
injection to help straight the eye(s) without surgery. Works better for
small angles, although it is less predicable than surgery. Also, less prone
to overcorrections than undercorrections.
Prisms really are for diplopia help, not so much for cosmetic strabismus,
although prisms can make the deviated eye seem less deviated when observed
through the glasses.
David Robins, MD
Board certified Ophthalmologist
Pediatric ophthalmology and adult strabismus subspecialty
.
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