Question

I developped Esotropic Strabismus at age 7 and have been wearing corrective bifocals since.
I am now 17 and my condition is still bad enough that i am wearing gleasses still.
I am also now beginning to have Myopia. i desperately want to get rid of my glasses.
My question is: should i go with surgery or contacts? And what are the respective prices?

(Dinky)

Answer:

Dear Dinky,

This is a difficult problem, and not easy to judge fully without additional information. As I understand it, you have successfully worn bifocals for ten years now. This should mean that you have convergent squint only when looking at near, that is induced by focusing (accommodative convergence excess). If this indeed it the case, you you should be very hesitant to change your treatment, because such patients quite often have complaints and are not easy to treat.
When irritated by the horizontal line in the glass, try varilux glasses. This is probably the best option.
When irritated by the glasses themselves, the only option is to wear myopic contactlenses after having surgery.
The surgery in my opinion should then consist of bilateral medial rectus myopexias (sewing the muscle belly to the globe), but that operation is not frequently done in America. Alternatively, bilateral medial rectus recessions (quasi lengthening the inner muscles) could be performed, but only if the latent angle of squint when looking in the distance exceeds 5 degrees.


(Herb Simonsz, MD, PhD)

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