Strabismus acquired though monovision contacts

Discussion in 'Contact Lenses' started by filmbuffchgo, Jul 21, 2005.


  1. I must say I have had a few patients in this same monovision situation, some
    by contacts, and some by LASIK.

    Burton Kushner is a very well respected (by me, anyway ...) strabismologist.
     
    David Robins, MD, Jul 22, 2005
    #21
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  2. ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^

    Couldn't agree more. Problem is, most LASIK surgeons pretty much ignore this
    advice.
     
    David Robins, MD, Jul 22, 2005
    #22
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  3. filmbuffchgo

    filmbuffchgo Guest

    In the full article by Kushner, one example of a change in refractive
    management (which brings about sudden onset diplopia) is the
    "intentional creation of monovision to treat presbyopia...In 7
    patients, monovision resulted in a breakdown of the stability of a
    previously well-controlled strabismus." These patients are categorized
    as "intentional monovision causing loss of fusion." Kushner goes on to
    describe a 50-year-old woman who began experiencing diplopia and
    intermittent exotropia of 20 PD after being fitted for monovision
    contact lenses. She obtained bifocals per the author's advice,
    resulting in the elimination of her symptoms, and "(s)he has been
    asymptomatic for 4 years."

    I really hope that patients undergoing refractory surgery get a
    thorough binocular vision workup. However, my research suggests that
    successful use of monovision contacts is sometimes used as a criterion
    for monovision laser vision correction. This gives me the chills,
    since my first three years of monovision were problem-free. (And look
    where I am now!)
     
    filmbuffchgo, Jul 22, 2005
    #23
  4. My guess is that this will lead to successful lawsuits, despite the iron
    clad consent forms. To ignore these issues given the literature should be
    considered to fall way short of best practice.
     
    Scott Seidman, Jul 22, 2005
    #24
  5. filmbuffchgo

    Dr. Leukoma Guest

    The take home message (for me, anyway) from this thread is that
    binocular vision disorders are all too often ignored and too often go
    undetected and undiagnosed. In the more than 20 years that I have been
    prescribing monovision, I am not aware of any incidents similar to
    this. Of course, I wouldn't be putting intermittent strabismus
    patients, or patients with high phorias into monovision, either.

    Contact lens monovision would be considered by most to be an elective,
    reversible procedure. The fact that your symptoms increased with age
    confirms what I said about the presbyopia being a factor in all of
    this. I am not a strabismus surgeon, but I have seen enough cases of
    adult onset strabismus to know that monovision isn't always a
    pre-requisite.

    Best,
    DrG
     
    Dr. Leukoma, Jul 22, 2005
    #25
  6. filmbuffchgo

    filmbuffchgo Guest

    Of course, monovision isn't a prerequesite! The Kushner article
    classifies the causes for acquired diplopia in 132 patients with
    long-standing strabismus as being attributable to changes in: (1)
    ocular alignment, (2) refractive needs or (3) refractive management.
    Monovision (which is classified as a change in refractive management)
    is just one of a number of causative factors. In this regard,
    age/presbyopia are relevant only to the extent that they necessitate
    the change in refractive management. I believe that Kushner's thesis
    can be extended from adults with long-standing strabismus to those with
    "latent strabismus" (whatever that involves, and how do you know if
    you're a "latent" ?). And from what I've read lately, the (latent)
    strabismus group is not uncommon in the post-laser-vision correction
    population.

    I hope that you will take the time to read the entire Kushner article.
    My eye care practioners here in Chicago seemed to be bright and caring
    people like yourself, but they were not knowledgeable about this issue.
    If they had been more responsive to my complaints about diplopia, I
    might not be posting at this site today since the breakdown described
    is apparently reversible in its early stages.
     
    filmbuffchgo, Jul 22, 2005
    #26
  7. filmbuffchgo

    Dr. Leukoma Guest

    Here are a couple of articles you should read regarding the onset of
    convergent strabismus with presbyopia. I think they apply in your
    case.

    =====================================
    Presbyopia complicating pre-existing strabismus.
    Oystreck DT, Lyons CJ. Department of Ophthalmology, University of
    British Columbia, British Columbia's Children's Hospital, Vancouver,
    BC.

    Stangler-Zuschrott E.
    [Convergent strabismus in the age of presbyopia (author's transl)]
    Klin Monatsbl Augenheilkd. 1976 Jun;168(6):775-83. German.
    PMID: 994382 [PubMed - indexed for MEDLINE]
    =====================================

    DrG
     
    Dr. Leukoma, Jul 23, 2005
    #27
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