Recurrence of strabismus after eye muscle surgery

Discussion in 'Laser Eye Surgery' started by gil286, May 8, 2005.

  1. gil286

    gil286 Guest

    I suffer from hyperopia and astigmatism (OD +3.00 -4.00, OS +2.00
    -3.00, no lazy eye), and recently had eye muscle surgery to correct the
    partially accommodative esotropia I've had for over twenty years (since
    the age of two).
    In recent years I'd only worn glasses for driving, but the doctor who
    operated on my eyes has warned me that if I don't go back to wearing
    them full-time, the esotropia will return. I'd be happy to hear group
    members' opinions on this - what are the odds of the esotropia
    returning if I continue to only wear glasses for driving, how long will
    it take, and is some sort of compromise possible (e.g. wearing glasses
    only for the more "demanding" activities)?
    Thanks in advance
    gil286, May 8, 2005
  2. gil286

    Dr. Leukoma Guest

    The accommodative/convergence system wasn't changed by the surgery, and
    the eyes will still be receiving the signal to "turn inward" when you
    accommodate. The glasses will help prevent this. Also, without
    adequate stimulus to fusion, your eyes will be free to wander. Clear
    and equal vision in both eyes is a powerful stimulus to fusion.

    How long will it take to degrade? Hmmmm, let me see, take the square
    of the refractive error spherical equivalent devided by the amount of
    strabismus in prism diopters to get the exact time in years....heck, I
    don't know the answer to that question.

    I would heed your surgeon.

    Dr. Leukoma, May 8, 2005
  3. Partially? It would be nice to know how much the accommodative
    component was. To me it's surprising that they waited 20 years to do it,
    or did you also have surgery at age 2?
    With that refractive error, I'd wear them or get contacts.

    I'd be happy to hear group
    I can't understand why you'd only wear them for driving. I'd think that
    reading and any other close work you might do might be even more
    important to do with them on, especially if the angle of deviation is
    greater at the near point, in which case bifocals or 2 different Rxs may
    be in order. The esot will probably return temporarily when you go
    without your glasses, but permanent damage is not likely regardless, in
    the absence of amblyopia.

    w.stacy, o.d.
    William Stacy, May 8, 2005
  4. This kind of surgery is normally done ONLY on the nonaccommodative part of
    the angle - that is, the angle WITH the glasses on.

    If you operate for the larger angle with the glasses off, you end up
    over-operating, and are straight only when accommodating (focusing), which
    you can't hold all the time. When not accommodating, the eyes will deviate
    outwards. During changes in accommodation, the angle will be variable.

    If you operate correctly for the angle with the glasses on, they will often
    cross again when glasses are not worn regularly. They then end up crossing
    more of the time, and the surgery is essentially wasted.

    Occasionally, one can ove-operate a bit and get away with it, but that is
    generally not the rule. Note that this depends also on the angle with and
    without glasses, at distance as well as at near.

    I, for one, do not over-operate in that fashion. I have seen enough unhappy
    campers who tried that, and I won't go there.

    BTW, you have enough astigmatism that you definitely should be wearing
    glasses full-time, anyway. I would be surprised if you had good enough
    vision for daily comfort without them.

    David Robins, MD
    Board certified Ophthalmologist
    Pediatric and strabismus subspecialty
    Member of AAPOS
    (American Academy of Pediatric Ophthalmology and Strabismus)
    David Robins, MD, May 9, 2005
  5. Chronic angling in due to accommodation with cause the return of the
    esotropia in many cases. True, it is not amblyopia, but there are more ways
    to "damage" the system besides amblyopia. This is permanent damage, in that
    you then need to repeat the surgery, which is detrimental.
    David Robins, MD, May 9, 2005
  6. Well your message got a little garbled, but I'm wondering what other
    kinds of damage you're thinking about. Accommodative esotropia is
    easily fixed by correcting the hyperopic/accommodative problem with
    glasses or contacts. I don't think accommodative esotropia should ever
    be "corrected" with surgery, except maybe refractive surgery.

    w.stacy, o.d.
    William Stacy, May 9, 2005
  7. Sorry if I wasn't entirely clear. I sometimes don't read what I have written
    and check for clarity.

    What I'm saying is, is that IF you operate for the nonaccommodative
    component, and then do not wear glasses, you get recurrent esotropiafrom the
    accommodative component, which may remain permanent even if you later try to
    go back to the glasses. The eyes can "take a set" at the esotropic angle,
    and even though wearing the glasses may reduce it somewhat, the eyes often
    "unwind" and remain esotropic even with the glasses on. Therefore, what was
    only the accommodative component (and could have been handled only with
    glasses) can again become a mixed accommodative and non-accommodative
    process requiring glasses and yet another surgical intervention.

    Therefore, the comment that not wearing glasses after surgery won't do any
    permanent harm is not exactly true. I was supporting your statement that it
    is not amblyogenic, but I was pointing out that there can be permanent harm
    done (to the alignment) by not wearing the glasses.

    I agree, wholeheartedly, that accommodative esotropia should normally not be
    corrected by surgery . HOWEVER, in the case of a mildly high AC/A ration,
    where the eyes cross mainly at near, it is a recognized procedure to operate
    for the near angle. This is, in a sense, operating for accommodative
    component to get a child out of bifocals. It is over-operating, and takes
    advantage of fusion (if it is there) to handle the distance exo that is
    created by operating for this near eso-deviation. I, for one, do not do this
    - I feel it is more prudent to handle the AC/A issue with bifocals, rather
    than surgery, because I have seen results from other surgeons where they do
    end up exotropic (not exophoric) in the distance.

    Hope this is more clear.

    -Daid Robins, MD
    David Robins, MD, May 9, 2005
  8. David Robins, MD wrote:
    HOWEVER, in the case of a mildly high AC/A ration,
    Definitely, and I think we're more in agreement than disagreement.


    w.stacy, o.d.
    William Stacy, May 9, 2005
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