Pending Eye Surgery, eyes don't work together.

[bjohn13]

I was born severely cross-eyed. I've had five eye operations, four on my right eye and one of my left.  My vision is very acute, but it is obviously better in my right than in my left.  My problem is that I can't get my eyes to work together.

The ophthalmologist I had when I was a child passed away about ten years ago.  My mother is medically illiterate, so she is no help.  I have an appointment with an ophthalmologist on December 23, but I'm a little worried.

In order to get my eyes to work together like they should, it takes a concerted effort, and it's getting worse.  Even when they do work together, the result is an image that doesn't blend together like it should (not quite double vision).  I have poor depth perception, but even worse, I cannot tolerate glare.  I can't drive at night, especially when it's raining, because of the glare.  I go to bed with a headache every night that I am certain is from eye fatigue.  I can't make eye contact with people because I can feel my left eye floating. When I control it from floating, I see the image not blend together like it should, and the result is that I don't feel comfortable conversing.

Does anyone have any ideas on this condition?  My resources are limited, and I'd like a little something to ease my nervousness.  I think my visit to the ophthalmologist is going to result in surgery, and my last surgery was quite painful.  Anyone who can point me to some resources or say anything to ease my nervousness would be greatly appreciated.

Thank you.

[bjohn13]

Thanks for your response, IMO.

I talked to my mother last weekend to see if she could fill me in on anything else.  She did state that I was 18 months old before she saw my left pupil and iris (after my third surgery).  I have a feeling that this may have led to poor development in the sight of my left eye (I vaguely reember wearing a patch from about 18 months to about four years over my right eye, and then getting my first prescription at age 4).  

Your post has made sense to me.  There have been a lot of quetions cleared up for me here, but I still have a feeling that the case I am dealing with is worse than the worst case scenarios that have been detailed here given my past surgeries.

The biggest help was in what to ask my doctor.  I'm not interested in cosmetic surgery to "cover it up".  I just want to be able to see normal again.

[I.M.O.]

hi,
i was reading ur post and found it interesting.

you say that you were born severely crossed-eye, this could be a factor to why you cannot use both eyes together as well as other people might. it also sounds like your left eye was the one that turned when you were younger.

hopefully ill explain this without confusing you.
in the brain, there are cells that function for the right eye, for the left eye and for both eyes together (binocular cells). because you were born crossed eye, the images received from your eyes were different and so the binocular cells did not have the chance to develop as well as the cells for each eye independently. reason why when you are concentrating on working with both eyes that the images do not blend together as well.

as for your eye drifting, and that you can alternate which eye you are seeing through, its all got to do with the eye muscles and innervation. you may notice that when you do with your left eye, your right eye may go out and down a little as well??

ok here is the main thing i want to point out, if your ophthalmologist does suggest to you to have surgery, ask for the advantages of having surgery and the disadvantages, is the surgery for cosmesis or other reasons? will you end up having double vision? ask for an assessment with an ORTHOPTIST, they specialise in assessment of binocular vision and eye exercises etc. they hopefully will be better to explain to you the "eyes dont work together" symptom.

for resources about the eye condition you have, i think you might want to try looking up "congenital esotropia", textbooks on binocular vision, ocular motility disorders may also be useful, you might find them in university libraries.

sorry for it being long, but i hope the post helped.

[bjohn13]

The one thing you said that interests me is about not being able to make my eye go up and out.  When I was a kid, before my fifth operation, I could consciously cause that to happen, but not by trying to move it that way.  If I relaxed the muscles in my left eye (stopped looking through it, or diverted my eyesight to my right eye), my eye would float.  I can't make this happen at present, but I have become familiar enough with the sensation to know when it happens.

It seems to me, though, that you've covered worst case scenario.  It's good to know that surgery may not be necessary.  At least now I know a little bit more about what I'm facing so I won't be totally in the dark when going to see my ophthalmologist in a couple of weeks.  

Thanks again.  I may post back here again if I have questions about my ophthalmologist's recommendations that might come up after the visit.

[Ag-i-doc]

as for your optometrist saying that he was "not going to issue another prescription"...thats an interesting statement.

most surgeons will not do surgery if your eye is not CONSTANTLY up & away.  so if you can "control" it, even if its uncomfortable sometimes to do so, IMO surgery is probably unwarranted.

the reason you cant MAKE your eye go up and out, is b/c no one can.  even those of us who have not had strabismus surgery cant.  the only thing a human can do is CROSS your eyes IN, or CONVERGE.  no one can purposely DIVERGE.  the nerves & muscles arent set up for that.  i am not saying your eye doesnt go left, it does.  i am just explaining why you cant thoughtfully MAKE it go up & left.  it happens when you're not paying attention or when you are tired, and you have to consciously make it go back in.  right?

okay if you have "severe astigmatism" (i guess it depends on one's definition of "severe"...i would call more than about 4 diopters of astigmatism a moderate to severe amount)...then you may need toric contacts in addition to prism glasses.

one of your best options may be a rigid bitoric contact lens fit.  that would make you see pretty well, even up your rx and focusing between the 2 eyes, and it would probably also be pretty easy to make prism glasses to go over them.

[bjohn13]

Thank you for your quick response.

I'm 30 years old, and it's been 20 years since my last surgery.  I have seen an optometrist about my eyesight, and he did prescribe a pair of glasses with a prism to correct what he called a severe stigmatism.  However, the last time I saw him, he told me he wasn't going to issue a new prescription because there was nothing wrong with my eyesight.  He seemed perplexed.  He also said it was obvious that I had had eye surgery, and he said it was likely that I would need it again, but instead of elaborating, he referred me to an ophthalmologist.  That was five years ago.  I didn't have health coverage at the time, so I waited.

I can see my left eye visibly float when looking in a mirror, but the only way is to catch it by accident while casually passing by.  I can't make it float, even though I can consciously decide which eye to look through.  When it does float, it moves up and to the left just enough to be perceptible.  It makes me uneasy seeing it, so I can only imagine how it makes other people feel.

Thanks again for your responses.  I'll do some research on some of the terms you suggested.

[Forum-OD-MP]

how old are you?

UN-likely that any eye doc will recommend surgery if you are an adult and you have decent acuity, and if you are not bothered too much by cosmesis (meaning your eyes look fairly normal to others).

there are multiple possibilities for your problems making the 2 eyes work together, given your history.  most if not all of them are fixable with non-surgical means.  if your ophthalmologist recommends surgery first, and you dont want surgery, then get a second opinion from an optometrist.

one of the easiest things to fix, and a high probability given the history you just told would be significant ANISOMETROPIA, which is a big difference between the rx in the 2 eyes.  if that is the case then you were probably an "accommodative esotrope" when you were younger, and that explains having more surgeries on one eye than the other.  this would be fairly easy to fix with CONTACT LENSES, but IMO glasses would probably be a poor choice depending on the extent of the anisometropia.  if the ophthalmologist tells you that your problems are from a big difference in Rx between the left eye and the right eye, then IMO you need contacts.  glasses will not work well b/c of difference in image size.  glasses only work well if the right & left rx's are close.

a little tougher to fix would be if you still had a tropia (crossed or uncrossed eye, or one eye UP or DOWN, even if you cant tell its crossed by looking in the mirror), or a large rx WITH tropia.  this would involve glasses with PRISM in them, or possibly even contact lenses with prism glasses on top.  glasses with prism in them are generally difficult to make and probably $100 or so more expensive than other glasses, so if this happens, dont expect anyone to be able to make it in "an hour" and also dont expect to get them for like 2 weeks after you order them.

the vast majority of these post surgical strabismus cases can be managed without further surgery, it just might involve wearing glasses or contacts or possibly even BOTH at the same time, which sounds weird, but could most likely fix your "eyes working together" problems and your headaches, eyestrain, etc.

good luck!