Horizontal deviation: surgery only if more than 30 prisms?

Discussion in 'Laser Eye Surgery' started by fresnelp, Dec 11, 2004.

  1. fresnelp

    fresnelp Guest

    Hi all,

    It seems that I have a horizontal deviation that is responsible for my
    double vision. It is 5-10 prisms at the far left and increases to 10-15
    prisms to the far right. It seems to me a considerable deviation.
    However, my Doctor said that horizontal deviation under, or equal to 30
    prisms poses no problem for the fusion in "normal" eyes. Ergo, it is a
    "brain" problem that I have, i.e. it's "inoperable". Is that correct?
    Sounds strange, bcause I had only 10 prisms vertical and got operated
    for that (that's how I got diplopia).
    Any comments would be greatly appreciated.
    Thank you in advance,
    Peter
     
    fresnelp, Dec 11, 2004
    #1
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  2. fresnelp

    Neil Brooks Guest

    Peter wrote
    I'm not a doctor, but have had three such strabismus surgeries--the third
    primarily to eliminate diplopia. Dr. Leukoma--if he chooses to chime in
    here--seems exceptionally well qualified to tackle your question, but I have
    a couple of comments and questions:

    1) It seems you have noncomitant strabismus -- the amount of deviation
    varies with the direction in which you look. Can you tell us your
    deviations in other directions? Do you see double in all directions?

    2) What is your alignment in "primary gaze" -- when you look straight ahead?
    I'd guess it's between the 5-10 and 10-15d, but. . . . .

    3) Is your alignment issue esotropia or exotropia? Is that consistent in
    all directions??

    4) Are they currently treating you with prisms in your glasses? If so, how
    is that working out?

    5) Do you still have any vertical deviation?

    6) What is your alignment when looking at /near/?

    7) Were you born with this deviation? You say you've had a prior surgery
    for a vertical deviation, so I take it there's /some/ history here. Keep in
    mind that fusion requires two things: a) adequate mechanical alignment of
    the eyes and b) an adequately developed fusional mechanism in the brain. If
    you never developed the latter, it's unlikely that you ever will. Further,
    if you never developed the latter, it's possible that your eyes will
    continue to drift post-operatively. Nothing in your brain knows to hold
    them in place.

    8) Is your ophthalmologist a specialist in this area? Is he/she a
    (pediatric) strabismus ophthalmologist??

    9) Have you talked with your ophthalmologist about Prism Adaptive Trials?
    It's a theory that says that you may have more underlying deviation than is
    readily apparent. It's tested by pushing increasing amounts of prism on you
    (via glasses) to see how much correction you'll tolerate. This is
    considered your 'actual' alignment error.

    10) How about refractive error? Are you near/farsighted, and--if so--how
    much?

    It's my understanding that many strabismus surgeons will cut at 12d of
    deviation, but /bear this in mind/: with an incomitant strabismus, *you get
    to pick one direction (virtually always primary gaze) in which your
    alignment is straight. In nearly all other directions, you will still have
    mis-alignment.

    Best of luck!

    Neil
     
    Neil Brooks, Dec 11, 2004
    #2
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  3. fresnelp

    fresnelp Guest

    Here's some exam results and the opinion of a well-known European
    professor:

    VOD (CL)=0.8 near VOD (CL)=1.0
    VOS (CL)=0.8 VOS (CL)=1.0

    Keratoconus oc.utr. Fundus - normal (OU).

    Bagolini F,N (+?), Lang I (-)

    Motility: Left superior oblique (+); Right superior rectus (+);
    Convergence (+)

    Prism cover F fix d +4.5; +2.5 VD
    N fix d +7.0; +2.5 VD
    Right F +7.0; +3.5 VD
    Left F +7.0
    Up F +8.0; -4.5 VD
    Down F +7.0; +2.5 VD

    BHTT (right, left tilt) +7.0; +2.5 VD

    This is an early onset esotropia operated late with no
    chances for binocularity.He has an A-dymptom and by the IR-recession LE
    the pre-existing incyclotropia has increased and by the IR-resection RE
    an excycltropia has been induced. This made things worse and I don't
    believe that he has any chances to get rid of the double image by
    establishing binocular functions.Cosmetically it is not bad so that a
    further operation for cosmesis is not necessary and would only bring
    the double image closer together. So I would not operate on him again
    but
    try to improve the situation by enhancing the fixation with the
    fixating eye just be leaving away the CL on the non fixating eye.In
    case he is
    still disturbed by the tilted image of the fixating eye you could
    selectively approach cyclo on this eye.
     
    fresnelp, Dec 11, 2004
    #3
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