Strabismus surgery. Am I a good candidate?

Discussion in 'Laser Eye Surgery' started by sithlord70, Mar 31, 2006.

  1. sithlord70

    sithlord70 Guest

    Hello
    I am 35 years old and have suffered from exotrophia since I was about
    6. Prior to that I esotrophic. I had 2 surgeries when I was a child on
    both eyes in the mid 1970's. Dr Marshall Parks in Washington D.C. did
    both. Not sure if each surgery was on one eye or if he did both eyes
    both times One was at about age 3. The other at about age 6. While
    the eso that I had with both eyes was gone I was left with exo. From
    what my parents told me, Parks said I had minor brain damage and that
    the eyes would never fuse. He also told that the brain turns the vision
    off in the eye that it is not using. One of his collegues said I would
    never be able to drive since I had no real depth perception. Well after
    the 2 surgeriest my parents did not pursue any more treatment after
    that so I suspect Parks did all he could do. I also wore glasses for a
    short time around age 4 or 5 not for my vision which was 20/20 but what
    I suspect was to help to correct the crossed eyes.

    So growing up from then on I've lived with my right eye turned out most
    of the time. My left eye which I use 95% of the time is straight as
    long as I am focusing with it. I have the ability to switch eyes and
    focus with the right eye but I have to consciously force myself. When I
    do this the left eye becomes exo. But contrary to what my parents were
    told by Parks about one eye being turned off, both eyes are indeed
    working simultaniously. The eye that I am not focusing with simply
    turns outward and acts as peripheral vision on that side but it is
    clearly still working. Oh and I had my eyes checked recently and I
    still have 20/20 vision.

    I was picked on growing up and as I entered adulthood I became very
    self conscious of it to the point where I have a difficult time looking
    people in the eye I don't know really well. Interviews are a nightmare.
    I know people see it because I constantly get people looking looking
    back over their shoulder when I talk to them. That makes me even more
    self conscious and I break eye contact from then on, usually looking at
    them in brief glances, turning my head so I am looking at them more
    from the corner of my eye which makes it less noticable or rubbing my
    right eye. Anything to make them not notice. I do this with most
    people, even those who may not notice. It made me getting ahead in life
    hard.

    Now I want to pursue strabismus surgery but I want to be sure I make
    the right decision on the choice of doctor and that the surgery is
    worth while. From what I wrote I was hoping maybe someone here,
    preferrably an eye doctor could give me some advice as to whether
    surgery is going to work for me cosmetically, don't care if fusion ever
    occurs though it would be nice. Also would I benefit from vision
    therapy/exercises. Also I want to find a good qualified and surgeon in
    the NYC area who has a alot of experience in adult and childhood
    strabismus surgery. Hope someone here can help.

    Thanks in advance,
    Adam
     
    sithlord70, Mar 31, 2006
    #1
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  2. sithlord70

    Neil Brooks Guest

    Adam-

    I'm certainly not an eye doctor, but your post has been gathering dust,
    so I'll take a stab at it....

    Theoretically, Parks was the best strabismusologist of his time. While
    I *did* see him myself (as a patient), he did not perform any of my
    three strabismus surgeries.
    If he got you straight, I'm not sure it would matter whether he cut one
    or both, especially if only one eye was turned.
    This is interesting. Were you ever evaluated by a neurologist?

    I'm going out on a limb here, but ... in *congenital* (now called
    "infantile") esotropes -- people born with an inward eye turn (that's
    me), it's very normal for the brain's "fusional mechanism" not to
    develop. In other words, if you're born withOUT an alignment disorder,
    your brain learns to fuse the two images that the eyes send, creating
    stereoscopic vision and depth perception. Presumably, this happens
    early.

    Parks likely meant that your fusional mechanism may not have developed
    properly. Mine didn't. The problem with this is: that fusional
    mechanism in the brain is sort of a "notch," making it far more likely
    that your eyes will maintain their correct alignment. Without that
    neurological facility for fusion, it seems very likely that the eyes
    will drift, even after excellent *mechanical* alignment due to surgery.
    It *can*, but it doesn't have to. In my case, I either alternated
    between eyes or *occasionally* used both, resulting in double vision
    (prior to each surgery).
    Nah. People with only one eye can drive legally and their depth
    perception is likely to be worse than yours.
    Very possible that they put you in prism glasses to correct a residual
    (leftover) alignment issues.
    Do they check your vision with your eyes dilated??
    That's a b**ch. I understand.
    Most strabismus surgeons use, as a guide, a minimum of about 12
    diopters deviation from straight before surgery is indicated. Two
    things have changed in the last 30 years that make the likelihood of a
    successful outcome better than your last surgery:

    1) Prism Adaptive Trials (where appropriate). This is where they put
    you in prism glasses of gradually increasing strength, trying to find
    out if you have more deviasion (exotropia) than ... um ... meets the
    eye. Your convergence mechanism may be struggling to straighten your
    eyes, leading to less apparent deviation than is actually present. PAT
    can elicit this;

    2) Delayed Adjustable Suture technique. Theoretically, I invented this
    ;-) They do the surgery, then--after a few days' healing to allow
    swelling to go down, they *then* adjust the sutures to optimize
    alignment.
    I know this isn't NYC, but the best guy I know of in the Northeast is
    David Guyton at Johns Hopkins:

    http://www.hopkinsmedicine.org/wilmer/employees/cvs/Guyton.html

    If you can't see him, perhaps he can recommend somebody -- maybe even
    one of his former fellows -- in your area. I'd definitely start with
    an evaluation by a top-notch strabismus ophthalmologist, asking him or
    her about the vision therapy first. That may be something appropriate
    for you, but--from what I gather about your situation--surgery is far
    more likely.

    Again ... it's really critical to remember: if you were born
    cross-eyed, there's every reason to believe that--even after an
    outstanding surgical result--your eyes may drift again.

    Best of luck, Adam.

    Neil
     
    Neil Brooks, Apr 2, 2006
    #2
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  3. sithlord70

    retinula Guest

    you've received a pretty good reply from neil brooks. he obviously has
    experience in the problem from a patient standpoint and has pretty good
    technical knowledge on the subject as well.

    there is a strabismus surgeon who sometimes posts on this forum-- dr.
    robbins i believe is his name. perhaps he will chime in. if not then
    repost your question with his name in the title and i bet he'll catch
    it.

    what is your acuity in each eye separately? i am interested
    specifically in knowing what the acuity is in the deviated eye (with
    the best optical correction).

    i think it is unlikely that you have had any "brain damage". you may
    have had some lose of acuity in the deviated eye (amblyopia) and most
    certainly your motility mechanisms are abnormal. i wouldn't consid
    this to be brain damage in the sense of the word that most people use.

    people who see with only one eye do have depth perception, but not
    stereopsis which requires binocular vision. a large percentage of the
    population is monocular and it doesn't affect your ability to drive
    safely or obtain a drivers license.

    keep looking for more information. i think much of what you have been
    told is not entirely accurate since its old hand-me-down information
    from doctor-to-parent-to-child. time also has a tendency to distort
    what was actually said. you are more "normal" than you think, and
    having vision in one eye is not a serious handicap. help with
    straightening your deviated eye is readily available.

    if your deviated eye has poor acuity as i suspect, what you are looking
    for is a cosmetic solution. that is certainly achievable. i recommend
    finding a good strabismus surgeon as you intend on doing. it also
    wouldn't hurt for you to just book an appointment with the closest
    strabismus specialist right away and then come armed with a lot of
    questions. your understanding of your situation and your options will
    increase exponentially after you leave.

    good luck

    retinula o.d. ph.d.
     
    retinula, Apr 2, 2006
    #3

  4. Actually, I am a former David Guyton fellow at Wilmer. However, I learned a
    lot from Marshall Parks during my residency in Washington. But, I learned a
    LOT MORE during the time I spent in Dr. Arthur Jampolsky's offices in San
    Francisco (while I was next door doing muscle research at the
    Smith-Kettlewell Institute, of which Dr. Jampolsky was the director).

    I don't have much to add to the this tread. Most of the pertinent points
    have already been raised. Doing another surgery will likely get a better
    alignment, but since there is no fusion, it is not guaranteed to stay
    straight over the long haul. The cosmesis may be better, though. Certainly
    adjustable suture technique is de rigeur here, as previously operated muscle
    don't follow the usual muscle surgery (Parks) tables. As Dr. Jampolsky used
    to say, when I asked him how much surgery he would do for a certain angle,
    his answer was : "enough". This is determined in large part by how the
    muscles feel, and the eye aligns mechanically during surgery. It does not
    take into account the innervational forces that change once awake.


    David Robins, MD
    Board certified Ophthalmologist
    Pediatric and adult strabismus subspecialty
    Member of AAPOS
    (American Association of Pediatric Ophthalmology and Strabismus)
     
    David Robins, MD, Apr 5, 2006
    #4
  5. sithlord70

    sithlord70 Guest

    Thanks everyone for your replies. I have another question. I've been to
    3D movies and while I have the special glasses on the double image
    isn't there, I always assume I am not really seeing the 3D effect
    because I only work with one eye and as I understand it both eyes must
    work to get that effect. Occasionally I swear I see the objects comin
    at me :) but most of time while the audience is ooing and ahhhing and
    grabbing at the air I'm not seeing anything dramatic if at all.
    Without the specials glasses on I can plainly see the images on the
    screen are doubled which is supposed to be the case. But with the
    glasses on looking at the screen I don't see that double image.
    Shouldn't I! I thought for the glasses to work I had to have fusion,
    which is what I thought combined that double image, and remember my
    eyes are not even looking in the same direction at the same time. How
    can my brain be fusing the double image into one? This confuses me. Oh,
    to enforce that point, when using binoculars I can only see out of one
    side at a time depending on which eye I switch to, but not both sides.
    As mentioned originally, the unused eye whichever at that moment, just
    goes exo. So whats the deal with the 3D appearing to work somewhat?

    Thanks again,
    Adam
     
    sithlord70, Apr 8, 2006
    #5
  6. sithlord70

    Quick Guest

    Ok, I don't have a clue but I wanted to make my guess
    before someone actually answers...

    Ummm, I believe the 3d glasses work on color/spectrum
    filtering. One side blue? one side red? The images on the
    screen are slightly displaced. one image you see primarily
    with one eye and the other image ou see primarily with the
    other eye. Varying the displacement of the images works
    with your depth perception to give the 3d effect. It wouldn't
    work in black and white. It makes sense that you see fine
    through the glasses but don't get the 3d effect.

    -Quick
     
    Quick, Apr 8, 2006
    #6
  7. I trained some with Marshall Parks in the 80;'s. Dr. Parks usually operated
    both eyes (medical rectus recession) for esotropia. If it recurred, he
    usually operated both eyes (lateral rectus resection). However, if the
    overly strong inwards brain signals weaken with age, and become more normal.
    The now operated muscles now let the eyes turn outwards. This is not an
    uncommon problem. I would try to get hospital records of the surgeries, so
    it is obvious exactly what had been done. Hopefully they still exist.

    By the way, I don't know why anyone would say you couldn't drive because of
    lack of depth perception. This is not a requisite for driving. A lot of
    people drive who are in your exact situation, since they have adapted to the
    lack of depth perception.

    While you may feel both eyes are being used simultaneously, they aren't or
    you would have double vision constantly. There is a supression scotoma,
    where PART of the vision is turned off,in the brain, to help keep diplopia
    at bay.

    Repairing this cosmetically is not that difficult, virtually any strabismus
    surgeon can. It is easier if the old records show what was done. I don't
    know anyone in particular in the NYC area, however.
     
    David Robins, MD, Apr 10, 2006
    #7
  8. sithlord70

    Dan Abel Guest

    As I have posted before, my wife is blind in one eye. I'm not, but I
    only use one eye. We both have valid driver's licenses.
     
    Dan Abel, Apr 10, 2006
    #8
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