Exophoria and prisms.

[Worldsprayer]

I am a 27 year old soldier who about 3 years ago had PRK to correct severe near-sightedness.  Earlier this year, I attempted to complete a physical to become a pilot, during which the eye doctor informed me that I have exophoria of approximately 16 diopters, enough to disqualify me for flight, even though I have never had a problem with convergence to my knowledge.  To be diagnosed was quite a surprise.  Since then, after my own research, I acquired some lifesaver vision cards to exercise my muscles that bring in the eyes, but due to my hectic lifestyle (it's the army!) I cannot keep with them very regularly.  I have read that prism-glasses can be used to correct over time exophoria.  Is this true and is it worth pursuing?  Is such a thing expensive?  (Trying not to involve tricare.)  Thank you in advance for any help.
-Chris

[JohnHaganMD]

To a certain extent we can all see with our eyes closed, we can perceive light, sometimes color if the colors and light are bright enough.  We we are asleep and our eyes shut and in darkness we "see" our dreams.  People see things during hallucinations and in a syndrome with poor vision called "Charles Bonnet" Syndrome. People see things during some types of seizures.

The prisms would have nothing to do with this they just bend light towards the pointed end. (apex).

You need to discuss what YOU see with your ophthalmologist and family doctor. You should go into see your personal physician about the neck pain.

JCH MD

[LadyHawkB]

Im 53 yrs old.  Experiencing the prisms over eyes now.  Can see when my eyes are closed as well.  Ive been stressed for a few days now.  Should i worry?  I get this at least once or more a month.  Also had pain in neck at base of skull for a week straight last month.  Any idea what can cause this?

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

No there is no cure for exophoria since it represents a balance of mechanical and brain control impulses that we neither fully understand nor can affect. We can control exophoria with strong fusion.  In an adult fusion exercises are of unproven benefit and many feel are not helpful in children. Having a clear image with glasses or contacts is important, in children alternate patching and over minus of glasses sometimes helps.

I have an exophoria and have had all my life. Yet I am an eye surgeon, have been in USAF and am a marksman with pistol and rifle.

There is a wealth of health things that we can control: weight, exercise, moderate or no use of alcohol, avoiding tobacco, good diet,  wearing seatbelts and driving responsibily, etc.

JCH MD

[Worldsprayer]

Is there no "cure" for exophoria then?  Whether or not it impacts my flight career or lack-there-of, I strive for health in all things and I would rather remove the problem altogether instead of live/adapt with it.  Thank you for response and any info you can provide.
-Chris

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

No these exercises would not be of help. Your probblem is not control of the exophoria but the amount. I would suggest getting the visual requirements for being a pilot then seeing a adult strabismus/pediatric ophthalmologist for a second opinion about the amount of your exophoria, perhaps a waiver, perhaps a measurement of a smaller amount.

Good luck and thank you for your service to our country. We have 14 individuals in our family that have served in the military including one stationed at Ft. Campbell (years ago).

JCH MD  USAF retireed