Horizontal deviation: surgery only if more than 30 prisms?

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

 

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

 

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.