Strabismus of the Eye

[Normandie]

May need strabismus surgery and have been searching for a top notch doctor in the field of adult strabismus surgery
I live in the Richmond Va area, but willing to travel to find the very best in that field.  Found a doctor in N.Y., but he does not take insurance, so that doesn't work as I am on a fixed income and don't have the money to do surgery exclusive of insurance.  
The strabismus I have appeared after cataract surgery, and it creates a vertical ghost image even with corrected glasses.

Any feedback will be greatly appreciated

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

I would strongly advise you to get several more opinions. your problem does NOT sound like real strabismus.  If one or more of the eye muscles are missing you should see TWO distinct objects one of which goes away when you close one eye.  If you see ghosting out of one eye with the glasses on this is NOT strabismus but may be a corneal or IOL problem.  Ghosting is not usually a symptom of strabismsus.  WITH YOUR GLASSES ON TEST ONE EYE THEN THE OTHER BY ITSELF. DO YOU SEE GHOSTING OUT OF EITHER EY.E.  

[Normandie]

Hi Dr. Haig,  
R.E has a retinal horseshoe tear, epiretinal membrane, hard drusen on fovea and after cataract surgery with a Nanoflex Lens, developed strabismus.  Without glasses if I cover one eye at a time, picture frame on wall will look normal,  if I then uncover both eyes at the same time picture frame is double with left top corner being higher than right top corner.  With glasses on vision in R.E is vertical ghosted.  I had two separate opinions with two retina specialist who did not think there is a problem with retina, nor do other  eye doctors I've seen think the problem has anything to do with the EM or the drusen.  I am considering a doctor who is the head of the Strabismus clinic at the Wills Eye Institute in Bala-Cynwood, Pa.  Two opinions here in Richmond: one prescribed new scrip which may or may not help (expensive process of elimination), and the other told me to see a doctor in Charleston, SC who was no longer practicing.  To add to this mix, because of too many surgeries (4) in L.E. due to removal of Restore lens, I have what I refer to as surgically induced glaucoma and I see out of this eye as though I'm looking through a sheer curtain.  I had an SLT and also had to have surgery  for the pupil which had a stitch one of the previous doctors somehow put there and created a cat's eye, so vision was even worse then.  I go faithfully for field vision test and medicate with Latanaprost.  I cannot see in the sun with this eye, must have sun glasses.  Even looking into indoor lighting is difficult.  Really bad vision in left eye.  My cataract surgery writes like a soap opera and my vision seems surreal to me, but I am trying to live with it as best I can and try not to dwell too much on the negative.

Normandie  

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

Can you post your glasses prescription and your vision in each eye WITH the glasses.  Wills Eye Hospital in Philadephia has a well-deserved reputation.  Given your surgical history, the status of your maculas and your description of your problem (and your evident bad luck with eye surgery), even in expert hands of a strabismus specialist this appears to be high risk/low success surgery. If you do see the Will Eye you might ask about prism glasses. Do be careful, the downside is that strabismus surgery could make the problem worse and instead of seeing ghost images you might have complete double vision.  Sorry I cannot be more enthusiastic.  You do not have true double vision now. And since you see ghosting in RE that does not lend itself to strabismus surgery and strongly suggest distorted vision from the macula/ERM in your RE   J Hagan MD

[Normandie]

Hi again, Dr. Hagan.

What tests should I take to check on the macula/ERM, although I probably have had these tests done in the past, but repeating them may be a wise decision at this time.  I believe the scrip I am now wearing  does have a prism in the RE, but I see ghosted  vision with this eye when covering the LE.   The doctor gave me a new scrip (below, not yet filled)  to see if there would be an improvement in my vision.  I suppose it is entirely possible that I have strabismus and something else causing the ghosting vision.  I should add that RE was yagged after surgery by a house resident and after a about 34 yags I lost count.  Could this have contributed to the problem I have?
New Prescription 6/27/22
          Sph              Cyl             Axis                  Prism
OD   -0.25           +2.25              170                      2 DN
OS    -0.75                                                                2 UP
OD                                               2.75
OS                 ADD                     2.75
  
Previous Prescription 4/29/21
           Sph              Cyl              Axis                 Prism
OD    -0.25            +1.75             180                      2 DN
OS     -0.75                                                               2 UP
OD                                                2.50
OS                ADD                       2.50

My ophthalmologist did not think the previous script was going to change my vision very much so I never filled the scrip for 4/29/21,  I just continued to wear what I already had.

  

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

What is your vision withy the glasses on?

[Normandie]

Dr. Hagan, I do not have clear vision with glasses on in either eye.  Eyes together, when not covered  one at a time is slightly better.  I am told in doctor's office that I see chart 20/20 and I tell them maybe in the office, but not "out there in the real world".  I see dr. 4/28 and perhaps can answer this question better than.  This will be a routine checkup only, no field vision test on LE.  Do you think it would be a good idea to see retina specialist,   and also check the macular/ERM again.  I can also test again on the 28th for eye dryness to see if that has progressed.  Use Thera Tears every morning and don't seem to have any annoying dry eye symptoms.  I truly appreciate all your input.  Such great advice will help me determine what I need to do next, and whether I should still consider a visit to the strabismus specialist.

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

yes, I would suggest you see a retina specialist.  Also if you have been told that in the doctor's office you see 20/20 with glasses in each eye but in the real world you don't see well part of it may be the distorted pupil failing to converge light like a normal pupil.  Your glasses have a total of 4 diopters of prism. that is  not a lot. I would get all the opnions you can before jumping into strabismus surgery. Ask the retina surgeon about that also.

[Normandie]

Will do!  Forgot to mention, 2nd strabismus opinion recommended that I do a single field analysis test which I did on 4/14/22, I believe it was okay.  Will check with ophthalmologist again, he never said anything at the time, so I am assuming it was okay.  Same strabismus doctor     recommended doctor (already retired) in Charleston because he did superior oblique procedure.   I feel like my vision has not remained stable since cataract surgery and thought with artificial lenses that vision wouldn't change, so visual changes must be due to other factors.  I see a difference in clarity even just around the house.  Reading also very difficult with progressives, and even with scrip. reading glasses.  May know more after Friday's apt. with ophthalmologist.  

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

Best of luck.

[Normandie]

Hi Dr. Haig,

Friday 4/28 visit Ophthalmologist   said eyes looked good.  Had OCT scan.  Will do Field Vision test in 3 months & retina test in October in his office.  Since April of last year, I now have had two OCT scans, and single field analysis test.  The tech told me that my vision with glasses on is 20/25-1 in left eye & I think the same in right eye.  Dr. thinks I should fill latest scrip and if no improvement we will talk about what to do after this. Sometime ago I saw, on his recommendation, a retinal specialist.  So I feel at this point that I should see  retinal specialist and perhaps another opinion re strabismus.  If it isn't strabismus & it isn't the retina or ERM, then it is a total mystery.  Do you agree that I should see retinal specialist  & another strabismus opinion?  Thanks Dr. Hagan.