progressive high myopia and strabismus

[cyvette]

Hi Dr. Kagan,

I'm a 30-year old femaie diagnosed with myopia around age 5.  Strabismus is associated with my poor vision, where my weaker eye relies on the stronger eye.  Correction for both myopia and strabismus started out with glasses, then soft contact lenses.  For a time, I used gas perm lenses, but had to switch back to soft lenses, as I often tend to lose the RGPs (worst was while crossing the street).  Strabismus seemed to have been corrected through prescription lenses by my late teens.

At an early age, doctors predicted that my refractive error will stabilize when I reach 20, but it did not.

About 7 years ago, young doctors (in their 30s) at the time recommended a double surgery - phakic IOL then LASIK, but it was usually done to much older patients (in their 60s).  A senior doctor (in his 50s) did not agree, fearing long-term effects weren't well-studied yet.  That is, what would be my condition when I reach my prime 10-20 years after the double-surgery.  Hence, I have continued with the corrective lenses.

However, I kept needing higher and higher-powered lenses.  Eventually, I had to wear glasses over contact lenses with maximum power.  I am now using -8.00 glasses (with about -2.5 astigmatism) over -19.5 contacts on both eyes.  Last year's check up showed my refractive error could be more than -30.00 but I am no longer able to tolerate higher powers of lenses/glasses, as I feel dizzy and nauseous.  My strabismus is also back, worse than ever, and glasses/contacts no longer work to correct it.  

I am now seriously considering surgery but will need to know what is the safest and most effective for my condition.  Plus, I would need to save up for it in maybe 3-5 year time.  

Could you direct me to reading materials on the latest research, procedures, practices and/or institutions that have specialized on this type of condtion?  

Would really appreciate all the help in the world right now.

Thanks!  

[Sandra M Brown, MD]

I am not Dr. Kagan but I see that your question hasn't been answered so I will step in.

First, it is unusual to continue to show extensive progression of high myopia after reaching adult years, so an underlying disease should be looked for such as retinitis pigmentosa or problems with the shape of the lens in the eye.  Is there a family history of this condition?

Second, the major risk factor for any surgery inside the eye is detachment of the retina.  This risk is greater if your eye is "longer" than usual.  Most highly nearsighted people have very long eyes but not always.  So it is important for you to know your Axial Length measurement.  If your eyes are not 'super long' and your retinas otherwise look healthy (not stretched or with holes) then this does reduce your chance of retinal detachment.

Finally, I would suggest that you try to find some way to improve your situation with only ONE surgery.  The most straightforward method would be to have 'cataract surgery' (even though you don't necessarily have cataracts) and to have custom lens implants put in.  You would probably need what is known as "minus power" implants and these are commercially available.  It would be safer for you to treat any leftover myopia with glasses, NOT LASIK.  If it were me I would not let myself be sold on any fancy lens implants like multifocal implants that you read about on this forum.

As a separate thought, it could be argued pretty easily that this procedure is not 'cosmetic' or 'for convenience' so if you have medical insurance it should be covered.

[jon501]

Sorry to hear of your circumstances.

The considered opinion is that the long-term effects of IOL's are still not known yet.

Has it ever been suggested to you that you could try contact lenses of a higher power of about -30. These are readily available. This would eliminate the need to wear a glasses/lenses combo and possibly overcome the feelings of dizzy and nauseous.

Hope this suggestion might help?

[cyvette]

Hi Jon!

Thanks for the tip!

My optometrists and ophthalmologists have always told me that the highest power of contact lenses is -20.  

Could you give me the brand please?  Are they toric, extended wear soft lenses?  
I will ask for it in my next visit the eye clinic.  

My eyes tend to be sensitive to some lens brands and solutions.  So I've stayed with Durasoft and Freshlook.  

[cyvette]

Thanks, Dr. Brown!

Yes, my condition is genetic.  Three out of 4 siblings have it, only the eldest was spared.  My mother now require -15.00 or so contacts.  Her myopia was diagnosed when she was 12.  She says one of her cousins also has high myopia, but I haven't actually met that relative.  

I don't have a record of my Axial Length measurement, but I would say my eyes are long cause they are both bulging.  

Would it be advisable to correct the residual myopia with contact lenses?  

Would strabismus be addressed by refractive surgery at the same time?

Is 'cataract surgery' the same as phakic IOL implant?

Could you direct me to studies of long-term effects of such a procedure done on patients around my age?

Sincerely appreciate your taking time to respond to queries such as mine.


Best regards