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Medical Forum / General / Vision / June 2005Correcting myopia worsens strabsmus: which to correct then???
Hi all, For a long time I've had a particular problem: -2.00 sph in the right eye, but when it's corrected *with glasses*, an existing strabismus worsens considerably (the other eye goes badly toward the nose). So I am facing a dilemma: correct myopia with glasses, and have surgery for the additional deviation, or correct myopia with laser surgery/intacs, in which case no "-" power will be necessary, hence no additional deviation and no need for strabismus surgery. What should I do? I have asked doctors, but they seem to avoid answering me. I still don't have an answer. Please comment. Thank you! Peter > Hi all, > > For a long time I've had a particular problem: -2.00 sph in the right > eye, but when it's corrected *with glasses*, an existing strabismus > worsens considerably (the other eye goes badly toward the nose). This should not happen when viewing far distances, unless the -2.00 is an over correction, causing you to accommodate at far. If it is only at near, as in high ac/a ratio, you just need to take them off to read, or get a bifocal with a +2.00 add in it. > So I am facing a dilemma: correct myopia with glasses, and have surgery > for the additional deviation, or correct myopia with laser > surgery/intacs, in which case no "-" power will be necessary, hence no > additional deviation and no need for strabismus surgery. No surgery is ever indicated for the accommodative portion of your strabismus. Having surgery for the non-accommodative portion is ok if other means fail (prisms, orthoptics, or a combo). Laser/intacs will have exactly the same effect as wearing the single vision -2.00s ALL THE TIME, so that would require reading glasses, again assuming all the above is true and correct. Wearing -2.00 contacts would simulate Lasik/Intacs so try them BEFORE committing to either procedure. w.stacy, o.d. Thank you all for your replies. If LASIK/intacs have the same effect as wearing "-" power all the time, how could LASIK overcorrection leading to presbyopia be explained? If I switch from having myopia to having presbyopia after LASIK, I will need "+" glasses. "+" glasses reduce deviation, whereas "-" glasses increase it. There is some dicrepancy here. More explanation would be much appreciated. Thanx Peter > > Hi all, > > [quoted text clipped - 21 lines] > > w.stacy, o.d. > So I am facing a dilemma: correct myopia with glasses, and have surgery > for the additional deviation, or correct myopia with laser [quoted text clipped - 3 lines] > What should I do? I have asked doctors, but they seem to avoid > answering me. I still don't have an answer. Please comment. Thank you! One eye turns in with minus lenses because you have to accommodate more. Accommodation stimulates convergence. If you have refractive surgery, you'll still have to accommodate, just as if you're wearing minus. The doctors expect the deviation to increase after refractive surgery. -MT I agree with Dr. Stacy, that if the deviation is worsened only at near, then a bifocal should do the trick, or reading glasses over the contacts. Refractive surgery creates the same effect as a contact lens, except that the power of the cornea is changed. But, what about the left eye? Is it amblyopic? If it is amblyopic, then having any kind of surgery on the right good eye is a bit foolhardy, IMHO. DrG Thank you for your replies. If LASIK/intacs have the same effect as wearing "-" power all the time, how could LASIK overcorrection leading to presbyopia be explained? If I switch from having myopia to having presbyopia after LASIK, I will need "+" glasses. "+" glasses reduce deviation, whereas "-" glasses increase it. There is some dicrepancy here. More explanation would be much appreciated. It turns out that I want to do LASIK and have an overcorrection in order to wear "+" lenses and have reduced accomodative strabismus. What's wrong with that logic? Thanx Peter It's not the + that reduces the deviation, it's the reduction in accommodative response that does it. Trust me, YOU DO NOT WANT TO END UP HYPEROPIC! That will force you to accommodate all the more. You will have a much worse angle when not wearing glasses, plus you won't see as well, and you'll still have the same angle you now have with the plus lenses. DON'T DO IT. w.stacy, o.d. > Thank you for your replies. > [quoted text clipped - 11 lines] > Thanx > Peter fresnelp@yahoo.com wrote in news:1119416385.792276.106770 @g43g2000cwa.googlegroups.com: > Hi all, > [quoted text clipped - 11 lines] > > Peter Aren't there some refractive surgery cases where a preop phoria becomes a full blown tropia post-op?? If this is the case (maybe some of the OD's can kick in here??) I wouldn't be so quick to assume that there won't be a need for strab surgery after refractive surgery. There are some recently published guidelines for assessming strabismus patients for refractive sugery: http://www.ingentaconnect.com/content/bsc/ceo/2005/00000033/00000001/art000 20 My school doesn't have a subscription, so I can't get the article. Perhaps somebody can help you out. Personally, if you're leaning toward refractive surgery, I think it's worth the forty bucks. Scott I believe this is the article you're talking about ... http://individual.utoronto.ca/immortality/Strabismus.pdf Am I even allowed to post that? :p Well anyway, I'm going to take it off of my webspace soon ... so if you click on the link and it doesn't work, just email me and I'll send it to you. ;) > fresnelp@yahoo.com wrote in news:1119416385.792276.106770 > @g43g2000cwa.googlegroups.com: [quoted text clipped - 30 lines] > > Scott silverblue001@hotmail.com wrote in news:1119466004.089324.175970 @g49g2000cwa.googlegroups.com: > I believe this is the article you're talking about ... > http://individual.utoronto.ca/immortality/Strabismus.pdf > > Am I even allowed to post that? :p Well anyway, I'm going to take it > off of my webspace soon ... so if you click on the link and it doesn't > work, just email me and I'll send it to you. ;) That's one! So, bottom line is that Kowal places patients with manifest strabismus in a "high risk" group for complications following refractive surgery. He says surgery is OK, so long as the patient accepts the risk of future strabismus surgery, and he recommends that refractive surgery take place before any strabismus surgery. He also makes recommendations as to techniques to be used during strab surgery if future refractive surgery is planned to enable normal microkeratome suction. What he doesn't do is show much data regarding outcomes. The OP should definately make sure both his strab surgeon and his refractive surgeon have a copy of this article! Scott I had such a case back in the mid-1990's prior to PRK and LASIK. The woman was a relatively high myope, and had become intolerant to contact lenses She was out of the range for RK. She was binocular, but the history shows that she sometimes became diplopic and esophoric if her prescription wasn't binocularly balanced just right. It turns out that (and against my better judgement) she wound up having a bilateral lamellar refractive surgery that left here scarred in the left eye and with severe irregular astigmatism in the right eye. The only way she could go back to work was with the old RGP lenses she had prior to her surgery. This was back in the day before lenses were generally available for that purpose. Because she was never able to achieve equal visual acuity by any means (her left cornea was scarred), he occasional esophoria soon broke down into a constant esotropia with diplopia, necessitating strabismus surgery. Since then, I have become aware of many more cases involving amblyopia and refractive surgery with tragic outcomes, as a less than satisfactory visual result on the dominant eye creates an unpleasant rivalry between the two eyes. DrG "Dr. Leukoma" <drg@leukoma.com> wrote in news:1119531237.487898.100010 @z14g2000cwz.googlegroups.com: > Since then, I have become aware of many more cases involving amblyopia > and refractive surgery with tragic outcomes, as a less than > satisfactory visual result on the dominant eye creates an unpleasant > rivalry between the two eyes. > > DrG Not really that surprising, from the lay point of view. If fixation is tenuous, and fixation is used to suppress a tropia, doing anything that would dork around with fixation seems to be an unwise thing to do. Scott |
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