Question
Hi. I'm 16, and I was born with crossed eyes. I had two surgeries to correct
it before the age of one, and one at age 11 for a wondering eye. After the third surgery, I
got double vision, and I have had it ever since. I have seen several specialists, all who
have been unable to get the two images to "fuse" with prisms. Therefore surgery is not an
option. I am currently in prisms as I prefer to have the two images close together than
far apart. I was wondering if there is any treatment out there to correct the "non-fusion"
problem.
(Andrea)
Answer:
Dear Andrea,
You have an awkward problem, for which there is no definite solution. As a matter of
fact, I just operated an identical case three weeks ago.
The most important fact in your story is the age, 11, at which you were last operated.
Under age ten, a child that is exotropic after surgery will only complain of doublevision
shortly after surgery. Weeks after he will be able to suppress the double image and
complain no more. After age ten, it gets progressively difficult to suppress the double
image for the patient when the eyes are made exotropic, and occasionally, a patient will
have to be operated back to the old esotropic angle of squint, to get rid of the double
image.
When this corrective surgery is not performed, like in your case, the situation may
deteriorate further, as the ability to suppress the double image when esotropic may also
be lost in patients in that age category. These patients then have lifelong double vision,
extremely annoying. The double image may hover around the main image, occasionally
overlap with the main image, but never forms a single image over a longer period. On
the other hand, the double vision is unlike the double vision that people that have
normally binocular vision see when they squint. It 's more intermittent in nature: every
now and then a double image pops up and confuses the patient. Now some of these
patients want the double images as much as possible apart, so that they do not get mixed
up. But most prefer to have the images close together. If you prefer to wear prisms to get
the double images closer together, you may well benefit from strabismus surgery. At
least, that 's what I did in the patient referred to above, and she is happy with it. It
depends on the current strength of the prisms in your glasses, they should be over 7
prism diopters to contemplate surgery.
Yours truly,
(Herb Simonsz, MD, PhD)
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