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Type of my phoria & prism treatment ?
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Type of my phoria & prism treatment ?

I have phoria in my eyes. The last optometrist gave me a 2 degree Base-down prism glasses which doesn’t help. I believe my exo phoria is much stronger than hyperphoria!. After less than 2 seconds of focusing my left eye sight starts to deviate to south east direction diagonally when I’m looking straightly or at a right object at most of gazes but not at all gazes my left eye deviates. And when I’m looking at left object the deviation is gradual to north east such as the shape of slash “/”. This is one my head is not moving, but it's tilting. When I read the sentence by moving my head to follow it I can prevent deviation sometimes.

What is the type of this phoria? What type of prism I should use? I suffer from this problem when I'm reading and using the PC.
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711220_tn?1251894727
You problem is not unique.  I developed diplopia with a vertical tropia and mild exophoria from my retrobulbar block for my retinal detachment surgery.  This varied a lot depending on how rested I was.  Phorias can be controlled with effort.  However, fatigue, medications, alcohol, etc can affect it. Vertical phoria are more difficult to fuse.  I used different prism and they did not work consistently.  After about 11 months I had a very new procedure called a mini tenotomy snip developed by Dr. Ken Wright ( I have known him since my internship).  This was done with topical anesthesia in his office and literally was a 5 minute procedure.  After about 4 to 6 weeks I am not using any prism glasses and have eliminated 90% of my diplopia.

My vertical tropia was about 3 diopters--too small for conventional surgery.

Dr. O.



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711220_tn?1251894727
You need to see an adult strabismus specialist.

Dr. O.
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Avatar_m_tn
Thank you Dr.
I went to several strabismus specialists; every one of them gave me different opinion:
1- One said I have hyperphoria less than 2 and exphoria less than 6, and no need for prisms or treatment!.

2- One told me I have hyperphoria around 5 in my left eye, and gave me a prism glasses. However, she said that I have 1 degree of exophoria in my left eye and 1 degree of esophoria in my right eye.
And the other gave me different measurements but no treatment.
Thank you for your advice but I would like to know what type of phoria do I have and what are the possible treatments?!
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711220_tn?1251894727
You problem is not unique.  I developed diplopia with a vertical tropia and mild exophoria from my retrobulbar block for my retinal detachment surgery.  This varied a lot depending on how rested I was.  Phorias can be controlled with effort.  However, fatigue, medications, alcohol, etc can affect it. Vertical phoria are more difficult to fuse.  I used different prism and they did not work consistently.  After about 11 months I had a very new procedure called a mini tenotomy snip developed by Dr. Ken Wright ( I have known him since my internship).  This was done with topical anesthesia in his office and literally was a 5 minute procedure.  After about 4 to 6 weeks I am not using any prism glasses and have eliminated 90% of my diplopia.

My vertical tropia was about 3 diopters--too small for conventional surgery.

Dr. O.



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Avatar_f_tn
I have a suggestion for you.  Set up an appointment with an experienced ophthalmologist (not an optometrist) who specializes in strabismus.  Since your deviation probably increases with fatigue, make your appointment as late in the day as possible (preferably early evening).  You want the doctor to see your problem at its worst so that it can be fully corrected.  The doctor should be able to provide treatment options for you.  
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Avatar_m_tn
Thank you Dr. O.

Your answer gave me hopes, although I didn’t find good strabismus specialists around where I live (UAE). I believe I have to look for a specialist outside where I live. Do you know a doctor who can do what Dr. Ken Wright did in the region of Persian Gulf or close to it?
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Avatar_m_tn
JodieJ,

Thank you for your suggestion. My deviation doesn’t increase much with fatigue. I always has it in certain gazes specially when I’m reading from PC, looking straight without head tilting, and looking at my right side without turning my head. As Dr. O said phoria can controlled with effort, but this only when I’m staring at one thing not in reading or looking at moving things. However, when I’m looking at the right side ,as I said, here I can not controller my phoria even with effort, and the left side image starts to deviate/separate to the direction of 4-5 o'clock.

I don’t know if I have only exophoria or I have hypertropia + exophoria!.
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711220_tn?1251894727
I will text Dr. Wright.  He has some fellows from the area.


Dr. O.
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711220_tn?1251894727
Jeddah Saudi--- Hanan Enany, M.D.

Dr. O.
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