Question
I developed a strabismus at approximately age 18.
(I realize this is unusual; however, I was examined
by an opthomologist just about every year when
I was growing up and he definitely did not see
a problem when I was a child) I'm now 44 and
had been seen by a surgeon and had surgery scheduled.
Then, in a final visit in preparation for surgery
which was scheduled in about 2 days ,the doctor
used two graduated prisms (?) to simulate the
correction. Unfortunately, with everything he tried,
I ended up with double vision and the surgery was
cancelled. Is that all? The doctor gave me a pre-
scription for bifocals and sent me on my way saying
there was nothing more that could be done. This probem
is not only cosmetic, but since I have decent vision
in both eyes, (correctable to 20-15 and better than
20-40 uncorrected) my brain constantly seems to
switch from one eye to the other although the right
eye is primarily dominant for distances and the
left eye is primarily dominant for reading. I usually
end up with headaches at the end of the day, and,
of course, have absolutely no depth perception. The
cosmetic problems of having two eyes looking in
different directions cannot be dismissed either. I
find people take it as an indication I'm not
listening to them or interested in what they are
saying. This has impacted on my career at times. So,
my primary questions are: 1) Is double vision a
common problem with adult correction? 2) Is there
anything else that can be done? 3) If yes to #3,
what do I look for in locating a doctor able to
treat this? I really can't afford to go from
dr to dr searching for a cure. I've just gotten
to the point I can return to work after scoliosis
correction surgery. (I definitely should have
picked a better body from the assembly line!)
(Cathleen Thompson)
Answer:
Dear Cathleen,
Unfortunately, the ophthalmologists that tried the prisms preoperatively is right: If you were unable to have both eyes aligned optically by prisms, and had severe double vision, you are almost sure to end up with double vision after surgery. And in my experience, these patients then get pretty desparate. In fact, I spend many operations getting these patients in an acceptable condition again, and that sometimes takes two or three operations.
These problem is complicated by the fact that you look with one eye at near and one eye in the distance. Such patients, in my experience, need lots of time and attention to prescribe the glasses that they feel most comfortable with. We usually let such patients try several combinations for a quarter of an hour each, while they walk around in the hospital, have coffee and do some reading. What correction is accepted very much depends on what has been worn earler in life.
(Herb Simonsz, MD, PhD)
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