Correcting myopia worsens strabsmus: which to correct then???

Hi all,

For a long time I've had a particular problem: -2.00 sph in the right
eye, but when it's corrected *with glasses*, an existing strabismus
worsens considerably (the other eye goes badly toward the nose).

So I am facing a dilemma: correct myopia with glasses, and have surgery
for the additional deviation, or correct myopia with laser
surgery/intacs, in which case no "-" power will be necessary, hence no
additional deviation and no need for strabismus surgery.

What should I do? I have asked doctors, but they seem to avoid
answering me. I still don't have an answer. Please comment. Thank you!

Peter

 

This should not happen when viewing far distances, unless the -2.00 is
an over correction, causing you to accommodate at far. If it is only at
near, as in high ac/a ratio, you just need to take them off to read, or
get a bifocal with a +2.00 add in it.

No surgery is ever indicated for the accommodative portion of your
strabismus. Having surgery for the non-accommodative portion is ok if
other means fail (prisms, orthoptics, or a combo). Laser/intacs will
have exactly the same effect as wearing the single vision -2.00s ALL THE
TIME, so that would require reading glasses, again assuming all the
above is true and correct. Wearing -2.00 contacts would simulate
Lasik/Intacs so try them BEFORE committing to either procedure.

w.stacy, o.d.

 

I agree with Dr. Stacy, that if the deviation is worsened only at near,
then a bifocal should do the trick, or reading glasses over the
contacts. Refractive surgery creates the same effect as a contact
lens, except that the power of the cornea is changed.

But, what about the left eye? Is it amblyopic? If it is amblyopic,
then having any kind of surgery on the right good eye is a bit
foolhardy, IMHO.

DrG

 

wrote in @g43g2000cwa.googlegroups.com:

Aren't there some refractive surgery cases where a preop phoria becomes a
full blown tropia post-op?? If this is the case (maybe some of the OD's
can kick in here??) I wouldn't be so quick to assume that there won't be a
need for strab surgery after refractive surgery.

There are some recently published guidelines for assessming strabismus
patients for refractive sugery:
http://www.ingentaconnect.com/content/bsc/ceo/2005/00000033/00000001/art000
20

My school doesn't have a subscription, so I can't get the article. Perhaps
somebody can help you out. Personally, if you're leaning toward refractive
surgery, I think it's worth the forty bucks.

Scott

 

I believe this is the article you're talking about ...
http://individual.utoronto.ca/immortality/Strabismus.pdf

Am I even allowed to post that? Well anyway, I'm going to take it
off of my webspace soon ... so if you click on the link and it doesn't
work, just email me and I'll send it to you.

 

Thank you all for your replies.

If LASIK/intacs have the same effect as wearing "-" power all the time,
how could LASIK overcorrection leading to presbyopia be explained? If I
switch from having myopia to having presbyopia after LASIK, I will need
"+" glasses. "+" glasses reduce deviation, whereas "-" glasses increase
it. There is some dicrepancy here. More explanation would be much
appreciated.

Thanx
Peter

 

Thank you for your replies.

If LASIK/intacs have the same effect as wearing "-" power all the time,
how could LASIK overcorrection leading to presbyopia be explained? If I
switch from having myopia to having presbyopia after LASIK, I will need
"+" glasses. "+" glasses reduce deviation, whereas "-" glasses increase
it. There is some dicrepancy here. More explanation would be much
appreciated.

It turns out that I want to do LASIK and have an overcorrection in
order to wear "+" lenses and have reduced accomodative strabismus.
What's wrong with that logic?

Thanx
Peter

 

wrote in @g49g2000cwa.googlegroups.com:

That's one! So, bottom line is that Kowal places patients with manifest
strabismus in a "high risk" group for complications following refractive
surgery. He says surgery is OK, so long as the patient accepts the risk of
future strabismus surgery, and he recommends that refractive surgery take
place before any strabismus surgery. He also makes recommendations as to
techniques to be used during strab surgery if future refractive surgery is
planned to enable normal microkeratome suction. What he doesn't do is show
much data regarding outcomes.

The OP should definately make sure both his strab surgeon and his
refractive surgeon have a copy of this article!

Scott

 

It's not the + that reduces the deviation, it's the reduction in
accommodative response that does it. Trust me, YOU DO NOT WANT TO END
UP HYPEROPIC! That will force you to accommodate all the more. You will
have a much worse angle when not wearing glasses, plus you won't see as
well, and you'll still have the same angle you now have with the plus
lenses. DON'T DO IT.

w.stacy, o.d.

 

I had such a case back in the mid-1990's prior to PRK and LASIK. The
woman was a relatively high myope, and had become intolerant to contact
lenses She was out of the range for RK. She was binocular, but the
history shows that she sometimes became diplopic and esophoric if her
prescription wasn't binocularly balanced just right.

It turns out that (and against my better judgement) she wound up having
a bilateral lamellar refractive surgery that left here scarred in the
left eye and with severe irregular astigmatism in the right eye. The
only way she could go back to work was with the old RGP lenses she had
prior to her surgery. This was back in the day before lenses were
generally available for that purpose. Because she was never able to
achieve equal visual acuity by any means (her left cornea was scarred),
he occasional esophoria soon broke down into a constant esotropia with
diplopia, necessitating strabismus surgery.

Since then, I have become aware of many more cases involving amblyopia
and refractive surgery with tragic outcomes, as a less than
satisfactory visual result on the dominant eye creates an unpleasant
rivalry between the two eyes.

DrG

 

Not really that surprising, from the lay point of view. If fixation is
tenuous, and fixation is used to suppress a tropia, doing anything that
would dork around with fixation seems to be an unwise thing to do.

Scott