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

Discussion in 'Optometry Archives' started by fresnelp, Jun 22, 2005.

  1. fresnelp

    fresnelp Guest

    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
     
    fresnelp, Jun 22, 2005
    #1
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  2. 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.
     
    William Stacy, Jun 22, 2005
    #2
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  3. fresnelp

    Dr. Leukoma Guest

    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
     
    Dr. Leukoma, Jun 22, 2005
    #3
  4. 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
     
    Scott Seidman, Jun 22, 2005
    #4
  5. I believe this is the article you're talking about ...
    http://individual.utoronto.ca/immortality/Strabismus.pdf

    Am I even allowed to post that? :p 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. ;)
     
    silverblue001, Jun 22, 2005
    #5
  6. fresnelp

    fresnelp Guest

    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
     
    fresnelp, Jun 22, 2005
    #6
  7. fresnelp

    fresnelp Guest

    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
     
    fresnelp, Jun 22, 2005
    #7
  8. 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
     
    Scott Seidman, Jun 22, 2005
    #8
  9. 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.
     
    William Stacy, Jun 22, 2005
    #9
  10. fresnelp

    Dr. Leukoma Guest

    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
     
    Dr. Leukoma, Jun 23, 2005
    #10
  11. 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
     
    Scott Seidman, Jun 23, 2005
    #11
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