Can my adult strabismus be surgically corrected?!
Question: I'm 36 years old. My vision problems have been causing increasing problems over the past several years.
I am farsighted with astigmatism and estotropic strabismus. As a child I wore glasses from the age of 2 to 14. I no longer wear glasses or contacts (can not find a prescription that greatly improves my vision or does not cause worse headaches). I have had many many prescriptions - single vision, bifocals, disposable contacts, astigmatism contacts, one contact, and glasses over contacts.
The condition is not affecting me cosmetically, rather I am very troubled by eyestrain, complete lack of depth perception and amblyopia.
I'm just learning more about my condition recently. It sounds like I have accommodative strabismus due to my farsightedness. Can I have lasix to fix the refractive error and if so, will that fix the strabismus or enable me to have eye muscle surgery? Will it help with amblyopia?
I need help, I've been to 15 eye doctors in 20 years!
Answers: I'm 36 years old. My vision problems have been causing increasing problems over the past several years.
I am farsighted with astigmatism and estotropic strabismus. As a child I wore glasses from the age of 2 to 14. I no longer wear glasses or contacts (can not find a prescription that greatly improves my vision or does not cause worse headaches). I have had many many prescriptions - single vision, bifocals, disposable contacts, astigmatism contacts, one contact, and glasses over contacts.
The condition is not affecting me cosmetically, rather I am very troubled by eyestrain, complete lack of depth perception and amblyopia.
I'm just learning more about my condition recently. It sounds like I have accommodative strabismus due to my farsightedness. Can I have lasix to fix the refractive error and if so, will that fix the strabismus or enable me to have eye muscle surgery? Will it help with amblyopia?
I need help, I've been to 15 eye doctors in 20 years!
People that are farsighted have weak lens systems in their eyes. This means that the cornea and the lens inside the eye, together do not bend the light enough so that it will focus on the retina as in normal or emmetropic people.
But, if they bend the lens by accommodating, as if to try and see close, they can increase the strength or power of the lens and allow those light rays to focus ON the retina, instead of behind it.
The amount of focusing energy required to bend the lens enough to focus on the retina depends on how 'weak' the lens system is. For instance,
using P as the power, and D as the distance in meters, the basic formula
P=1/d gives the power of the lens.
So if a lens focused light a 1 meter away, it'd be a +1.00 lens.
If it focused light at a half meter away, +2.00.
third of a meter, +3.00
quarter of a meter, +4.00
fifth of a meter, +5.00
tenth of a meter (10 cm) +10.00
etc.
Normally for a normal person to see close up to read, they will use about +3.00 diopters of accommodation to see up close. As that happens, two other components of accommodation occur. The pupils get smaller, which increases the 'depth' of focus, AND, the eyes converge, so both eyes are directed at that closer object of regard.
But in far sighted people, if they are basically -3.00 too weak, then they have to crank in, for instance +3.00 of power to see at distance clearly. Then to see close up, another +3.00, so that makes it so they need +6.00 d of power to read. They get tired easily, get headaches, eyes tear a lot, eyes get red...eye aches. etc, mind wanders, hard to study for any length of time...
In accommodative esotropia, that person, in order to see at distance puts in enough power of accommodation to see clearly at a distance. If it's a lot, then the brain thinks that that person is trying to read, so the eyes pull inward or become esotropic or cross eyed, just looking at a distant object. This is accommodative esotropia.
the correction for this isn't surgery, it's correcting the power of the lens system so that NO energy is used while looking at distance. Put a pair of the right corrected lens in front of this person, and the eyes straighten out. The eso is gone.
IF, because the person didn't get correction till it was sort of too late, as they look at a distance, the eyes cross and the brain will decide that one of those images isn't right and will say to ignore it. This suppression amblyopia is the cause of the lazy eye or amblyopic eye. We do not tolerate double vision very well at all. I mean, which lane do you drive in? so we learn to ignore one eye, the suppressed eye.
If you have an accommodative esotropia, the 'best' surgery for YOU wouldn't be a lasik or lasek type of surgery. You'd do much better with a refractive lens exchange. This is basically cataract surgery without the foggy lens or cataract. And it works just fine. (I did it this way and I think the results are satisfactory, for me at least). Since you have a weak lens, the new lens they use to replace the old one, or a lens in front of the old one will be of higher power than for normal eyes. So if they usually use a +20, you'd get a +26 or a +30 lens, or whatever lens would be righf for you. Your esotropia will resolve on it's own as you'll not need to crank in all that power to get into focus.
In another 5 years you'll be presbyopic, which you sort of already are, so consider this type of surgery seriously. You may feel free to contact me if you want a surgeon nearby. I'm in southern California (San Diego area).
Don't do the refractive cornea surgery. You'll not be happy with the results and you'll have altered the surface structure of your eye and will need the lens surgery in the not so distant future anyway.
As far as muscle surgery goes, you don't need it. Not with this diagnosis.
see http://eyescareandvision.blogspot.com/