Surgery an option to improve vision?

[michaela54]

I am 53 years old with a history of eye problems since kindergarten.  Currently I have severe myopia, strabismus (2 ops when I was younger), and severe atigmatism.  I also have Sjorgrens (well-controlled at present) treated with four punctal plugs and restasis.  (That's just the eye part.)  At my most recent exam, I was told that I'm seeing 20/25 in each eye.  Outside the doctor's exam room, I'm having considerable problems with distance and near vision.  I'm also  seeing double.  Because of the Sjogren's, I'm stuck with glasses (after 42 years of wearing contact lenses).  The doctor says he can't add prisms without distorting my vision correction.  He DID suggest cornea transplants as the only way to improve my vision.   I'm trying to research this so I would appreciate any thoughts or guidance.

michaela

[John C Hagan III, MD, FACS]

This is one that I would seek second and even third opinion. Corneal transplants are big, big operations with healing times of up to 1-2 years. 20/25 is generally considered way too good of vision to consider a corneal transplant.  I don't see how a corneal transplant is going to help a strabismus problem like double vision. Corneal transplants on Sjorgren's patients raises the possibility ofother problems like corneal melts. This just doesn't compute.

I would start out with consulting a strabismus specialist (often found under Pediatric ophthalmologists).  I would also consult a well though of corneal--refractive surgeon.

Don't rush into corneal transplants. Also please read the archives and use the search feature to study all the posts about dry eyes and the other things you can do like pills (TheraTears Dry Eye Formula and/or fish oil). Dry eye lid sprays Tears Again.

JCH III MD

[michaela54]

Thank you for your response.  A member of the Sjogren's list-serve suggested the difficulty with visual accuity had to do with visual accommodation.  I may be interpreting this incorrectly, but it seems that while I'm in the office looking at the eye chart, 20/25 is achievable, while in the 'real world,' with varying visual demands, my eyes simply cannot accommodate efficiently.  

I have been under the care of a cornea specialist for some time, but my corneas have improved to the point that I only need to see him once a year.  The dry eye issue is pretty well under control even though I can't wear contacts anymore.  I do supplement the restasis (BID) with systane PRN.  (I have also recently started taking the TheraTears supplements.)

I don't believe the ophthalmologist who recommended the cornea transplant saw that as a remedy for the strabismus.  He seemed to be saying that my current status was as good as I can get and offered the cornea transplant as an option when I pushed him for options.

Thank you, again.  

[John C Hagan III, MD, FACS]

Visual acuity testing in the Eye MDs office is under the best of all conditions: no glare, good contrast, no wind.   That's why glare testers were developed. Many patients could see 20/20 in the Eye MD office even with posterior subcapsular cataracts but at night driving on a blacktop road they were 20/400. So you do see worse outside our offices.

JCH III MD