Refractive surgery for amblyopia in adults

[Otilia]

Hello,
I've noticed that very few doctors recommend refractive surgery (lasik, IOL, etc) for amblyopia (especially anisometropic amblyopia) in adults and I wonder why. Is it because they consider that it can't be corrected at all in adult age, maybe because the brain would not accept anymore the binocular vision if it is too late? Refractive surgery can't improve at all the vision for amblyopic pacients? I had an IOL surgery for my amblyopic eye almost 3 weeks ago, because my doctor highly recommended this implant for me... and I wonder ...should I question my doctor profesionalism? I am 31, and my vision is: RE: -8 LE: -1 (both have miopia and astigmatism). Now I still wear glasses, with diopter for the LE, and for RE I had phakic IOL iris-claw type, with -8 refractive power. For the moment my vision is double, and I understand that it will take a while till I'll be able to see just one normal binocular vision, it's about the neuroadaptation to the new vision. I hope it will not take too long till I'll be able to see normally because it's very hard to live with double vision. Before surgery I used mostly my left eye, because the amblyopic eye had a diopter of just -2.5 in glasses. I would highly appreciate if I could get any help in this matters, because I'm worried about my decision regarding IOL surgery. Thank you for reading this.
Thank you very much !

[Michael J Kutryb, MD]

Refractive surgery, as a general rule, will not give you vision that you could not get with glasses or contact lenses.  So if you had poor vision with glasses in the eye with amblyopia, then you would at best, have vision similar to what you had with glasses.  Now on the positive side, you might be able to get rid of very thick and bothersome glasses and go to sometimes not glasses or at least thinner glasses.  Surgery cannot correct amblyopia in adults but it can make the refractive error less so your glasse prescription would be less but the end best possible vision with or without glasses would be the same.  There can be other benefits sometimes however like better balance between the eyes and the ability to wear thinnner glasses and sometimes no glasses.

Michael Kutryb, MD
Kutryb Eye Institute
Titusville, FL
Edgewater, FL

[Otilia]

Thank you so much for you reply, it was helpfull ! If I don't ask for too much I would have another question.. You are saying that my vision after IOL can't be other than it was before, when the correction was made by glasses. The fact is that before IOL, my glasses had the following diopters : for the right eye: the glasses had a refractive power of -2.5 lens for an eye that has -8 diopters - this was the maximum diopter possible for correction with glasses because of my anisometropic amblyopia ; I tried to wear contact lenses but I could't stand them (they should have a -8 refractive power for this eye). For the right eye I had a -0.75 diopter at my glasses and the eye has -1 diopters. So now the IOL give me a correction of -8 instead of only -2.5, as I was used to all my life. I't a difference of 5.5 diopters that I have to get used to, and it was very hard till now (and it still is after 3 weeks) to accept this new vision but I'm optimistic to belive that I'll be able to see normal at some point in the near future I hope.
I couldn't find too many informations on the internet about anisometropic amblyopia in adults so I would appreciate a lot if you could give me some advices related to my situation. Thank you so much!

[Michael J Kutryb, MD]

I'm still a little confused by your description of what you had.  In this situation, the best I can come up with is that you had a very large refractive power difference between the eyes that was so large that glasses were not really an option unless one eye was left very much undercorrected for the sake of avoiding terrible double vision and headaches.  The natural solution in that situation is usually a contact lens which could easily balance things out.  Since you could not wear contact lenses, the surgeon recommended a phakic IOL as a way to balance out the eyes - which is one possible approach to the situation.  I cannot make any comment on whether is was right for your particular case since I am not your physician.  It does sound like you are still having some balance issues so the surgery may not have gone as planned, I'm guessing.  You should get a second opinion from another ophthalmologist in your area who can review your actual records, examine you and give you some advice.

Michael Kutryb, MD
Kutryb Eye Institute
Titusville, FL
Edgewater, FL

[Otilia]

Thank you for your answer. Your description of my case is wright. If the
glasses with a 100% correction for the amblyopic eye (-8.00) would had give me terrible double vision and headaches if I weared them, is there a chance
that the IOL to give me similar simptoms ? I wonder if my double vision is
normal and if it is, when it should begin improving? How long should I
wait to realise if IOL  was a good choice for me? I guess there is a maximum time allowed for vision to recover (1,2..4 ? months), and if the vision is not ok after this period, a decision can be made.
Left eye: -1.00 (correction: glasses of -0.75); Right eye: -8.00 (correction: -8.00 Phakic IOL)

Thank you very much!