Strabismus acquired though monovision contacts

I am a woman in my 50's who began wearing monovision contacts about 9
years ago. I began experiencing occasional episodes of horizontal
diplopia during my 4th year of monovision under specific circumstances
(mostly night driving and watching movies in a theater). The
ophthalmologist I consulted dismissed my concerns, telling me that he
experienced double vision himself when he wasn't feeling well. So I
continued using monovision, although the episodes of diplopia increased
in frequency during each of the next five years. I decided to stop
using monovision this spring (against the advise of my optometrist),
and that's when my real vision problems began! The episodes of diplopia
occurred throughout the day (distance vision only), impairing my
ability to function. After a couple of useless consultations with eye
care professionals, I found an optometrist who diagnosed strabismus and
prescribed prism glasses (OS 3BO OD 3BO). The prisms (which are quite
heavy) eliminate almost all of the diplopia, but my depth perception is
still impaired. The optometrist also suggested vision therapy, but he
did not appear to be too optimistic about the probability of successful
results. So I am now considering strabismus surgery. Despite my
research, I cannot find a single study about treating someone with my
history. In case it is relevant, I did not have strabismus as a child
and have no family history of the disorder. My glasses prescription is
OD-5.50-1.50x175 OS-6.00-1.00x175 ADD +2.00. Any
information/suggestions for treatment would be greatly appreciated!

I assume the base out prism glasses were combined with the high minus
spectacle correction. If that is true, then it sounds like they just
didn't give you enough prism. Go to an O.D. who deals with binocular
vision (or back to the prism prescriber) and have him/her measure
exactly how much prism it will take to get you comfy, and get glasses
with your minus AND that amount of prism in them. You'll do fine. BTW
the glasses should NOT be that heavy. Base out prism in -6 lenses is
almost a no brainer and should not make the glasses all that heavy.

w.stacy, o.d.

filmbuffchgo wrote:

> I am a woman in my 50's who began wearing monovision contacts about 9
> years ago. I began experiencing occasional episodes of horizontal
> diplopia during my 4th year of monovision under specific circumstances
> (mostly night driving and watching movies in a theater). The
> ophthalmologist I consulted dismissed my concerns, telling me that he
> experienced double vision himself when he wasn't feeling well. So I
> continued using monovision, although the episodes of diplopia increased
> in frequency during each of the next five years. I decided to stop
> using monovision this spring (against the advise of my optometrist),
> and that's when my real vision problems began! The episodes of diplopia
> occurred throughout the day (distance vision only), impairing my
> ability to function. After a couple of useless consultations with eye
> care professionals, I found an optometrist who diagnosed strabismus and
> prescribed prism glasses (OS 3BO OD 3BO). The prisms (which are quite
> heavy) eliminate almost all of the diplopia, but my depth perception is
> still impaired. The optometrist also suggested vision therapy, but he
> did not appear to be too optimistic about the probability of successful
> results. So I am now considering strabismus surgery. Despite my
> research, I cannot find a single study about treating someone with my
> history. In case it is relevant, I did not have strabismus as a child
> and have no family history of the disorder. My glasses prescription is
> OD-5.50-1.50x175 OS-6.00-1.00x175 ADD +2.00. Any
> information/suggestions for treatment would be greatly appreciated!
>

While you have prisms of 6^ total,there is no information as to the actual
deviation readings at distance in primary position, and looking left, right,
up and down. In addition, the angle at near is needed.

This information would help tell something about the kind of acquired
strabismus that you have. Monovision may have played a role, in causing a
mild pre-existing deviation to "break down". In addition, it is not uncomman
at this age to have minor deviations become symptomatic. Question is, is the
angle stable?

If the 6 prism is just enough for comfort, but the angle itself is actually
much larger, would be nice to know. In general, the threshold for most strab
surgery is about 15 prism. Is it possible to do single-muscle surgery for
slightly smaller angles, but in general, if the total angle is only 6, most
people would not operate.

David Robins, MD
Board certified Ophthalmologist
Pediatric and adult strabismus subspecialty
Member of AAPOS
(American Association of Pediatric Ophthalmology and Strabismus)



On 7/20/05 8:55 PM, in article
(E-Mail Removed). com, "filmbuffchgo"
<(E-Mail Removed)> wrote:

> I am a woman in my 50's who began wearing monovision contacts about 9
> years ago. I began experiencing occasional episodes of horizontal
> diplopia during my 4th year of monovision under specific circumstances
> (mostly night driving and watching movies in a theater). The
> ophthalmologist I consulted dismissed my concerns, telling me that he
> experienced double vision himself when he wasn't feeling well. So I
> continued using monovision, although the episodes of diplopia increased
> in frequency during each of the next five years. I decided to stop
> using monovision this spring (against the advise of my optometrist),
> and that's when my real vision problems began! The episodes of diplopia
> occurred throughout the day (distance vision only), impairing my
> ability to function. After a couple of useless consultations with eye
> care professionals, I found an optometrist who diagnosed strabismus and
> prescribed prism glasses (OS 3BO OD 3BO). The prisms (which are quite
> heavy) eliminate almost all of the diplopia, but my depth perception is
> still impaired. The optometrist also suggested vision therapy, but he
> did not appear to be too optimistic about the probability of successful
> results. So I am now considering strabismus surgery. Despite my
> research, I cannot find a single study about treating someone with my
> history. In case it is relevant, I did not have strabismus as a child
> and have no family history of the disorder. My glasses prescription is
> OD-5.50-1.50x175 OS-6.00-1.00x175 ADD +2.00. Any
> information/suggestions for treatment would be greatly appreciated!
>

Actually, the base out prism glasses are combined with the +2.00 ADD to
be worn over my (non-monovision) contact lenses. Despite several
adjustments, the weight of the prisms constantly drag them down my
nose, making it hard to find the reading correction at the bottom of
the lens.

Any suggestions for restoring my binocular vision, or am I stuck with
the current status?

I seriously doubt that your strabismus was entirely the cause of the
monovision. I have prescribed monovision in thousands of cases without
inducing strabismus. This will only happen if the patient has latent
strabismus that is held in check by both binocular fusion and
accommodation. Adult strabismus typically breaks down during
presbyopia. Most people, however, will experience more problems at
night because of the lack of peripheral visual cues.

Interesting that the strabismus is apparently esotropia. In a myope, I
would have expected exotropia, convergence insufficiency, or divergence
excess. Some vision therapy may be indicated at this point along with
some adjustment of the prism, and/or the prescription.

DrG

filmbuffchgo wrote:
> Actually, the base out prism glasses are combined with the +2.00 ADD to
> be worn over my (non-monovision) contact lenses. Despite several
> adjustments, the weight of the prisms constantly drag them down my
> nose, making it hard to find the reading correction at the bottom of
> the lens.
>
> Any suggestions for restoring my binocular vision, or am I stuck with
> the current status?
>
You could try some orthoptics/vision training, but eso is hard to help.

Regarding your prism glasses, if they are made for over your mono
contacts, then this is not a very good arrangement. I mean why bother
with mono if you're wearing glasses over the contacts? Why not go full
distance Rx and make the prism glasses bifocals? And they should NOT be
heavy as you stated in the original post. In a reasonable sized frame,
3^ lenses should be quite light, and could be made VERY light in Trivex.

w.stacy, o.d.

Dr. Leukoma wrote:

> I seriously doubt that your strabismus was entirely the cause of the
> monovision.

I hope you meant "doubt your monovision was entirely the cause of the
strabismus".

w.stacy, o.d.

Of course I did. Thanks for sweeping up after me.

Now, strabismus can be the cause of monovision if it causes amblyopia
:-)

DrG

Of course I did. Thanks for sweeping up after me.

Now, strabismus can be the cause of monovision if it causes amblyopia
:-)

DrG

Of course I did. Thanks for sweeping up after me.

Now, strabismus can be the cause of monovision if it causes amblyopia
:-)

DrG