I'm and adult with alternating consecutive exotropia and am
considering surgery.  My biggest concern is doing anything to
compromise my vision or developing diplopia as a result of the
surgery.

My brief history...

I had infantile/congenital esotropia.  I had 3 childhood surgeries.
The first surgery was before age 1, the second surgery I was 5 and the
third surgery I was 8.  After the first 2 surgeries my eyes eventually
turned back inward.  Weeks after the third surgery I ended up with
constant alternating exotropia.

I have no diplopia now and no amblyopia.  I am myopic but correct to
20/20 in my dominant eye and 20/25 in the non-dominant eye.  I'm in my
mid 30's.

I was evaluated by a pediatric ophthalmologist who is willing to
perform surgery on my non-dominant eye so I can gain cosmetic
alignment.  During the evaluation the PO determined that my primary
means of compensating for the misalignment is via ARC and not
suppression.  Only the smallest prism on the vertical prism bar did
NOT induce diplopia.  All other prism induced diplopia.  The PO said
that statistically I have a higher chance of having post operative
diplopia than someone who suppresses.  I think that with my angle of
deviation most people typically suppress rather than employ ARC.  The
PO feels that if I have postoperative diplopia that it would
eventually disappear.

Because of my concern for developing diplopia the doctor suggested
using a temporary Fresnel prism on my glasses to see if my brain
adapts to the surgical alignment.  I don't know my actual angle of
deviation.  The prism prescription is for 35 diopters.  I believe that
if I adjust to this prism the doctor may be order a stronger prism -
but I may be wrong on this point.  I'm currently waiting to have the
prism applied.

Finally, onto my real question....

In all my reading on ARC, I understand that ARC has allowed me to have
a greater level of binocular vision than someone who compensates
primarily by suppression.  What mechanism will my brain use (ARC vs
suppression) to combat the diplopia post surgery?

My concerns are:

1.  Developing diplopia that does not resolve.  (I know this is a
small risk but there are no guarantees.)

2.  Suppression will be used to combat the diplopia.  If suppression
is used won't I be losing the binocular function that I have today????