alternating strabismus surgery type

hello,

I have an alternative esotropia.Yet,i talked to 2 different surgeons in different clinics.And their opinions about surgery are different.One of them wants to operate only one eye,two muscles,,another wants to operate only one muscle on 2  eyes.Both of them are pretty sure that their method is the only good one.
What should i do ?I've read on internet that it is better to operate 2 eyes in alternating strabismus .Is that right ?

Also i have a small vertical deviation.Like 3-4 dp..I talked about that with only one surgeon so i don't have 2 opinions here.He says he don't wants to operate such a small angle.But im not pretty sure about that either.Maybe he don't wants to do it because of his low skills and he don't wants to take risk because of possible over correction.But that doesn't mean its good for me.

Please,give me your opinion about this two questions.It is really important for me to know the truth.So i chose whats best for me.

Nick

[John C Hagan III, MD, FACS, FAAO]

1. Hate to be a killjoy but you will never have perfect binocular vision and perfect fusion. Most strabismus patients especially those with birth onset or constant strabismus for any period of time do not have it. Perfect vision means: 1. both eyes have excellent corrected vision 2. both eyes are pointed at the same object of regard at all times 3. the brain takes these clear images and perfectly integrates them to give perfect depth perception, peripheral vision and fusion.

You may have some fusion but it will not be perfect fusion or will you ever have perfect depth perception (stereopsis). That doesn't mean your eyes won't look straight or that you will be a bad driver or athlete. There are many olympic athletes that have strabismus, severe amblyopia and even some with only one eye. The Kansas City Chiefs football team had an all star tight end with only one eye (Fred Arbanas).

All surgery has risks, just like all travel in cars and planes and bikes has risks. In order to have straighter eyes you will need to accept the risks. If you deal with a highly trained strabismus Eye MD surgeon you have lowered the risks to the lowest possible level.

Evidence based study of "visual training" has only demonstrated that it helps convergence insufficiency. THat is not your problem.

Best of luck.

JCH MD

[John C Hagan III, MD, FACS, FAAO]

I live in Kansas City, I have a meeting coming up in Branson soon. There are several ways to get there driving. I've talked to several people that favor different routes. Bottom line they all end up in Branson.

Surgery is no different. You can get the results by operation on both or either eye. So both are acceptable surgical approaches. The amount of verticle deviation is too small to operate on; given you have poor fusion and always will even if your eyes are made straighter the only reason to do anything verticle is if it created a cosmetic problem and 3-4 prism diopters is not noticible.

I would go with the surgeon you feel most comfortable with.

JCH MD

[NickPol]

thanks,I feel much better now^^.and actually i have a fusion with 20dpt prisms.I also have a constant double vision.right now i wear prisms for 15 dpt and i see much better in them.

Thats why im terrified of over or under correction and staying with my double vision forever.I heard it is almost impossible to make "perfect eyes" with only 1 surgery. What do you think of that ?

And also what size of verticle deviation should be operated on in my case(with double vision) ?(i think it gets bigger than 4dpt when im tired )

And my last question.I've read some of you posts where u say that conservative vision therapy is useless.Actually i wanted to get some sessions to stabilize my binocular vision after the surgery.But since its really useless,why to pay money for it ?

Hope i didn't bother you too much with my stupid questions .That are my last ones,i promise^^

[John C Hagan III, MD, FACS, FAAO]

1. Hate to be a killjoy but you will never have perfect binocular vision and perfect fusion. Most strabismus patients especially those with birth onset or constant strabismus for any period of time do not have it. Perfect vision means: 1. both eyes have excellent corrected vision 2. both eyes are pointed at the same object of regard at all times 3. the brain takes these clear images and perfectly integrates them to give perfect depth perception, peripheral vision and fusion.

You may have some fusion but it will not be perfect fusion or will you ever have perfect depth perception (stereopsis). That doesn't mean your eyes won't look straight or that you will be a bad driver or athlete. There are many olympic athletes that have strabismus, severe amblyopia and even some with only one eye. The Kansas City Chiefs football team had an all star tight end with only one eye (Fred Arbanas).

All surgery has risks, just like all travel in cars and planes and bikes has risks. In order to have straighter eyes you will need to accept the risks. If you deal with a highly trained strabismus Eye MD surgeon you have lowered the risks to the lowest possible level.

Evidence based study of "visual training" has only demonstrated that it helps convergence insufficiency. THat is not your problem.

Best of luck.

JCH MD

[NickPol]

Thank you !In fact non of my eye doctors could give me such clear answers to all of my  concerns !

[John C Hagan III, MD, FACS, FAAO]

Thank you Nick.
JCH MD

[zena983]

Hi there,

I have recently noticed that my 4 year old son has been having his eyes wondering in different directions, kind of cross-eyed. I have been noticing this occur once every week or so. I took him to the doctor and the doctor said he had perfect eye vision but his eye has a weak muscle that is not allowing his eyes to align together. The doctor also suggested using a patch. But Im not sure if that is a good idea. Can you please give me your opinion on this? And whether this would require surgery? Or do you suggest leaving it?

I appreciate your reply!

Thanks
Zena

[John C Hagan III, MD, FACS, FAAO]

The problem is an eye muscle one and that is called "strabismus". There are several types of strabismus some don't require any treatment other than "watchful waiting" while others require glasses, patching and even surgery.

Your child should be under the care of a pediatric ophthalmologist. Find one near you at www.aao.org    You child will need to be watched carefully and frequently for the next 8-10 years.  

Get in to find a pediatric ophthalmologist you can get to regularly and if you have other children have them checked as this often runs in families.

JCH MD