Correcting stabismus as an adult

[krp74]

Hello.  I'm 32 and have had poor eye alignment and nearsidedness since birth.  Around age 4, I had my eye muscles tightened to try to help the alignment.  It improved it, but it's never been good.  As it stands now, my left eye is my heavily dominant eye and the alignment is at it's best in this situation.  When I choose to use my right eye, the left eye shoots up to the outside very badly and always makes people question where I'm looking.

I had lasik last Nov, which helped my nearsidedness.  Now, it's left me with two questions:
1. can the alignment be corrected after having lasik?
2. what challenges would I face if I chose to pursue having the alignment corrected?  (i.e. would I see fine or would my brain have trouble compensating for the change and cause double vision, headaches, etc.)

Thanks for your time.

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

Glasses and contact lens are both fine for correctling myopia. Because the contact lens is closer to the eye, the image is larger and for higher grades of myopia the vision is often better with contacts than glasses. However contacts are not "better" for the eye nor does the glasses or contacts make the eye more nearsighted.

The myopia and strabismus are two different problems. Most Eye MDs would not do additional eye muscle surgery unless your eye control was faltering badly and your eye was "out" more often thatn "in line".

To find either an ophthalmologist that is an strabismus specialist or a refractive surgeon you can go to the American Academy of Ophthalmology website  www.aao.org and use the "Find An Eye MD" feature to find a board certfied, Fellow in the American Academy of Ophthalmology in your city. You would likely be extremely pleased with LASIK.

JCH MD

[maddog1013]

A related discussion, Lazy eye repair? was started.

[hogglelady]

I have bilateral exotropia and had surgery for it when I was 13.  I didn't have problems keeping my eyes alligned unless I was sleepy or daydreaming, surgery just helped me with that.  After the surgery I had very rare occurences of misallignment or double vision.  Now (I'm 27) it seems to be getting a little worse.  My allignment is still fine usually, but when I am tired or looking farther away I've noticed that it is a little harder to bring them back together and a little more frequent.  I will be going back to the doctor but I am new to the area an am confused about finding a doctor I trust with my eyes.
My question here is about LASIK and strabismus.  I was once told by my doctor that strabismus is helped by glasses and contacts and that contacts were better (for correction) because the lense was closer to the eye.  (I actually wear glasses 99% of the time because I'm too irresponsible with contacts.)  Would LASIK help strengthen my eyes some?  I've always desperately wanted to correct my vision (L: -5.75, R: -5.25) with LASIK as soon as I heard about it but held off because my problem with strabismus was more important.  I don't want to have strabismus surgery again if I can help it so any advice about vision therapy and if it could help me would be appreciated

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

krp74     For some additional information on eye alignment problems please see the post in the Ophthalmology forum of 5/17 from irishdrummerboy. Some of that is germane to your problem.

Since you were born with poor alignment of your eyes (congenital strabismus), the centers in your brain that nomally keep the eyes pointed at the same thing (fusion centers) are very weak and poorly developed. The failure of your eyes to align and work together (fusion) after your first surgery reduces the success rate (prognosis) for additional surgery and it will likely not be possible to develop the perfect fusion that most of us are blessed to have (binocular coordinated single vision with perfect depth perception).

Your lasik will not be a factor in additional eye muscle surgery. Each additional operation on your eye muscles will have a lower success rate than the previous. The biggest risk would be that the cosmetic appearance of your eye might not be improved, an additional risk would be double vision.

Your best course of action would be to see a Pediatric Ophthalmologist (EyeMD) that does adult strabismus surgery. Only after a complex set of measurements are done would it be possible to estimate your chance of success and outline the risks and complications of surgery.

Remember that strabismus and amblyopia (reduced vision due to misalignment or blurred vision in one eye) are often hereditary. If you have children they should be check as an infant if the eyes are out of alignment or the child does not seem to see well or follow objects or look at faces. If all seems normal a complete medical eye examination should be done by an ophthalmologist or pediatric ophthalmologist about age 3 to search for strabismus or amblyopia (that may be too small to be noticed by parents). These recommendations would apply to anyone related to you by blood that has infants and children (nieces, nephews, children, grandchildren).

JCH MD