PRE OP TESTING FOR STRABISMUS

My teenager son has undergone strabismus surgery for 3rd time.  Once at 2years old then 5 1/2, now at 13y.o.  He was born with turned in eye and after 2nd surgery moved out again.  He now has double vision, torsion and colour problems.  My son's eyes don't fuse.  Can you tell me if prior Prism Testing is an accurate test for determining whether a patient will get permanent double vision after this surgery?  Also I have heard that after the age of 8 years old this surgery becomes very risky due to brain and signalling?  Concerned mum

[Ray T Oyakawa, MD]

Yes, prism testing is a good test.  The fact that he has double vision is a good sign.  Your last concern is appropriate.  However,  how did he do after his last surgery at age 5 1/2.

Dr. O.

[EyeQuest]

After my son's last surgery at 5 1/2 he did not have double vision or torsion.  Its this last operation done in Jan this year at the age of 13.  We have sought another opinion and were told that his double vision is permanent and no surgery will bring him back to normal vision again.  They have tried with Prisms and can't get him to fuse at all.  Basically because my son does not fuse we were told it was a good indication NOT to do any surgery.  Also because he has torsion makes it worse.  What do u recommend? Kind Regards Mum

[Ray T Oyakawa, MD]

I would get another opinion.  If he see double due to stabismus, then prism should align the eyes.

Dr. O.

[EyeQuest]

Dear Dr, the reason for his surgery was to improve his cosmetic appearance.  Are you sugguesting he wears 'thick lenses' prisms for rest of his life which defeats the purpose of having strabismus surgery?  We already have sought a second opinion.   How can his double vision be good, after being told it was permanent?

Should my son have undertaken the synoptophore test before the surgery to assess the brain's ability to adjust to the eyes being in a new position and hopefully prevent permanent double vision?  thanks