Surgeon advice

[davo2008]

I wonder if you could offer some advice about chooseing the right surgeon to perform strabismus surgery.

Is any opthmologist that performs strabismus surgery as good as the next one?

The reason i ask is because i have two options available to me, one is an opthmologist in my local hospital that amongst other procedures he performs he also does strabissmus surgery, and the other option is a strabismus expert at a very prestigous deadicated eye hospital.

The obvious answer seems to me that the strabismus speiaclist would give the best chance for sucessful surgery, but the problem is the waiting list to see him is twice as long. As i dont work in the medical world it is hard for me to know for sure what is the best route to take, especially as strabismus can be very hard to treat. Would you say that one surgeon can give you better chances of sucess than another surgeon?

Of course it is impossible for you sayanything for sure without being in full possesion of the facts, but would you advise it is worth waiting to see the strabismus speiacialist?

Also would you say that Moorefields eye hospital in London is as good as its reputation? (i have been told it is world renonud so i assume you have heard of it)

Would you agree that it is probally the best place in the United Kingdom (possibly the world) that offers eye health care?


Thanks in advance.

[John C Hagan III, MD, FACS]

There is nothing in the world that all professionals do the same. We call all appreciate the difference in skill in professional athletes. They are all "professionals" but some are obviously much better than others.

Consider it a second way. There are many people that do a fine job of driving an automobile around the country. There are only a few that can drive a Formula 1 car safely in a race.

So for straightforward uncomplicated common strabismus operations the local eye surgeon probably does a fine, fine job. For unusual, complex, very difficult cases the strabismus specialist will probably do a better job.

As bottom line as I can make it: if its a simple operation and the local surgeon has a good reputation and does a substantial number of these cases you may well be best off locally.   For anything so unusual that your local surgeon has not much experience then you are probably best off at Moorsfield.

Yes Moorsfield has an excellent reputation.

JCH III MD

[davo2008]

Thanks Doctor Hagan you have been very helpul.

My local hospital is a general hospital, and the surgeon there is more of a general opthamologist that performs strabismus surgery as one of the strings to his bow (so to speak), as far as his reputation and and the number of strabismus surgerys he performs i dont really know (but he is the top guy at my local hospital, so i assume his reputation must be fairly good), that sort of information is not eally available to patients in the United Kingdom and when i asked my GP about this information i was told one opthmologist is as good as another which is the reason for posting my questions. In fact when i asked my GP to refer me to Moorsfield he tried very hard to disscourage me, almost insisting i see my local opthmologist. I believe it is very bad form that there is nowhere in the UK that patients can find information about surgeons/opthamologist, and are left at the mercy of our GP's choice.

I do believe that my case is difficult one as i have already had an unsucessfull surgery 9 months ago. When i saw the strabismus specialist at Moorsfield he was confident he could get a good result from surgery in fact his exact words were ' i will get your eyes close, your eyes dont work together they never have and never will, the trick is to make everyone think they do'.

I do however have another question for you, the strabismus specialist in Moorsfield said i my eyes dont work together, they never have, and never will. But i do see with both my eyes at the same time, now i know the vision is weaker in my exotropia eye but i do definately see with both my eyes at the same time and if i close my exotropia eye my field of vision decreases.

Is there an explanation for this?

And how can my eyes not work together and yet i can still see with them both at the same time?

Thanks in advance

[John C Hagan III, MD, FACS]

Eye that don't work together or that have weak fusion use the vision from the peripheral vision and fuse into one image but do not fuse images from both macula. That is why your depth perception is not normal.

JCH III MD

[davo2008]

Thanks Doctor Hagan you have been very helpful again. Sorry to be a nuisance but i have got another question.

Does the fact that my exotropia eye is only used for peripheral vision give me worst chances of getting good alignmet from surgery?

I understand that i will not get any depth perception, or 3d vision after surgery, or improved vision after surgery, but does that mean the chances are i will not get a good alignmnet either?

I know you cant give me any definative ansewers without examination, but going by your experience and the general rules applied to patinets with a similar case to my own any advice you can give would be great.

If it helps you offer advice, i have also been given a test to see if i will have double vision after the surgery and the test showed i will not have any double vision. I thought that would be the case because after my surgery 9 months ago, my eyes were in good alignmnet for the first 3 months and during that time i did not have any double vision which actualy surprised the surgeon.


Thanks in advance

[John C Hagan III, MD, FACS]

Surgical success rates diminish with each subsequent surgery.  Surgery is less successful in people that do not have perfect fusion and depth perception (stereopsis).  The fact that you did not have double vision means you "suppress" when lowers the success rate.

JCH III MD

[davo2008]

Thanks again for taking the time to answer my questions Doctor Hagan, it is very good of you give up your free time to offer advice.

Do you think an accumalaton of all the lowered success rates, lowers the overall success rate significantly to the point where surgery probally wont work? or does it just simply mean the the odds are worse but it is still worth surgery?

Would you agree that my case is a difficult one and it would probally be best for me to see a strabismus specialist?


Thanks in advance

[John C Hagan III, MD, FACS]

No operation works all the time. If both surgeons have recommended surgery then it might be inferred that the chances of success outweight the lower risk of not being helpful.

You seem more comfortable with the idea of a strabismus specialist doing your surgery so it might be worth the longer wait for you.

JCH III MD

[davo2008]

Thanks again Doctor Hagan.

As the strabismus specialist recommended surgery aswell then hopefully the chances of success do outweight the lower risk of not being helpful. I have researched strabismus surgery sucess rates on the internet, a lot of the information contradicts each other, and it is also hard to determine what bracket i fall in. I have congenital strabismus (i think i am right that this is when you are born with starbismus), although i was born with esotropia not exotropia, the esotropia was corrected by surgery when i was about 3 years old. My alignment was fine until i was about 20 - 21 years old when i started having intermitent exotropia, the intermittent exotopia became constant after my failed surgery 9 months ago. As i was born with eso and the intermittent exo didnt start untill i was 21 it is hard to determine (because i am no an opthmologist) if the exo is deemed to be after visual maturity (when it happened) or before visaul maturity (as i was born with eso).

From what i understand if i am deemed as exo after visual maturety then there is a approx 80% success rate from surgery. If i am deemed as exo before visual maturity then i have approx 60% success rate.

Would you be able to tell me which bracket i fall into? My eyes were definately straight untill i was 9 years old (which as  understand it is the cutt off age for visual maturity).


Yes i think tyou are right that i might be worth the longer wait, because my esotropia as a baby was treated successfully at Moorefield, the strabismus specialist was confident he could get a good result (which i think is a good sign), and after my failed surgery 9 months ago i was discharged from the surgeons care 2 weeks after surgery.

Do you think 2 weels after surgery is to early to discharge a patient? i have read that it takes 6 - 8 weeks after surgery to predcit the final outcome in which case 2 weeks seems very early to me.


Thanks for your continued help it is very much appreciated, and sorry for the long post.

Thanks in advance

[John C Hagan III, MD, FACS]

Most of your questions will need to be answered by the surgeons that are attending you. With strabismus which is a life-long problem one would not expect to be discharged at 2 weeks.
JCH II MD

[davo2008]

Thanks for all your advice and taking the time to answer my questions Doctor Hagan, you have been very helpful, and made my decision a lot easier to make.

[John C Hagan III, MD, FACS]

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[davo2008]

After you were so helpful last time i wonder if you could offer some advice on some more questions i have. After speaking to my surgeon he says he would like to operate on my dominant straight eye, and move into alignmnent with my exotropia eye. He also said that he likes to slightly overcorrect the, and that if the slightly overcorrected eye holds it alignment afer 3 months then it should hold for a long time.

Is it normal to operate on the dominant eye? is the better chances of success by operateing on the dominant eye? if sugery does not work on the dominant eye could the result be neither of the eyes being straight?

Also is it good practice to slightly overcorrect does it imporve the chances? would you agree that after 3 months if the eye has held its alignment then it should do for relatively long time?

Again i know it is impossible for you give any definative answers withot examination but any advice you could offer due to general rules and your experience would be much appreciated.

Thanks in advance.

[John C Hagan III, MD, FACS]

Yes, Yes, No, Yes, Yes.

JCH III MD

[davo2008]

Thanks once again Doctor Hagan for taking the time to answer my questions it is very good of you and very much apreciated.  

[John C Hagan III, MD, FACS]

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[davo2008]

Hi Doctor, sorry to be a nuisance but i have got another question for you if you dont mind.

I went to see my GP today and he prescribed me a topical Minoxidil solution, the Minoxidil has several side effects most of which are not very drastic and are fairly easy to spot, but one of the possible side effects of the Minoxidil is lowered blood pressure (this is the side effect that i am worried about).

Could lowered blood pressure effect my strabismus? or my strabismus surgery? or my chances of strabismus surgery success?

I did ask my GP these questions but unfortunately he didnt know the answers and told me i would have to ask an opthmologist.

The reason i thought lowered blood pressure might effect my strabismus is because i know sickness, tiredness or stress can have an effect on strabismus, so i thought it possible lowered blood pressure could have an effect to.

Thanks in advance

[John C Hagan III, MD, FACS]

No and good luck growing hair.

JCH III MD

[davo2008]

Thanks Doctor, I will need all the luck i can get.

Sorry for taking a while to reply but i have had a few problems with my internet connection the last week.

[John C Hagan III, MD, FACS]

Not having internet access is the pits.

JCH IIMD

[davo2008]

Yeah the internet is such a good resource (especially such a helpful forum like this one) its hard to imagine life without it.

[John C Hagan III, MD, FACS]

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[davo2008]

Hi Doctor i have a couple more questions for you if you dont mind.

After strabismus surgery when the healing process has finished, will i be able to take part in contact sport without affecting my eyes? I play a lot of rugby which if you are not familiar is a sport where you can take a lot of blows to the head.

Also i was wondering would different climates be a problem, say for example if went travelling in America or Australia which is a lot hotter climate than here in the United Kingdom, could the heat or maybe the flight affect my strabismus?


Thanks in advance.

[John C Hagan III, MD, FACS]

After a decent interval for healing (varies perhaps 4-6 weeks) I would think you could participate in contact sports. You may need to wear sports protective glasses or goggles. Climite should not affect strabismus one way or another.

JCH IIMD

[davo2008]

Thanks once again Doctor Hagan for taking the time to answer my questions, as usual you have been very helpful.

I am curious to wheather i would have to wear protective googles in the short term or long term because for playing rugby at least i dont think it would be allowed. If it means i would have to stop to playing that would be unfortunate but so be it after all we all have to make sacrifices in life.

Also on the travelling side of things would travelling by plane effect strabismus? either the altitude or the pressures involved with air travel, i ask because i first noticed my strabismus return after i went abroad a couple of years ago. Do you think air travel could have effected my strabismus or do you think that it is just a coincedence.

Thanks in advance.

[John C Hagan III, MD, FACS]

1. Long term, good idea for anyone playing contact sport to war eye protection
2. coincidence

JCH IIMD

[davo2008]

Thanks Doctor Hagan as usual you have been very helpful.