Have fun with strabismus!

Solutions

This is not an issue in the "fun" category, but I thought a little bit of consumer information might be useful. This information only applies to infantile strabismus in adults. By this contradiction in terms I mean strabismus aquired before 6 moths of age, with which, assuming you're older than 10 by the time you read this, you're stuck now.
It is not known what causes strabismus. It's effects on the development of the visual systems in the brain are known to a certain extent.These effects are permanent and cannot be fixed (lots of "behavioral" optometrists will disagree with me on this one!). It requires a very elaborate system consisting of 12 extra-ocular muscles, several different oculomotor systems in the brain, and feedback from visual input, to keep them pointing in the same direction all the time - no matter how you move your eyes. In adult strabismus some or all of these systems have some defect or another ("Does this mean I'm brain damaged?" No! Your hardware is OK, it's just a few software bugs, and nobody knows how the heck to upload a new release - yet.) So chances are that if your eyes are aligned your software won't be able to handle it. Might even give you a horror diplopia. Unless you already have a horror diplopia or the deviation is "cosmetically conspicuous" it is not worth the trouble to correct it. The simplest way to check whether or not your particular software will accept a corrected positioning of the eyes is using prisms. That way the alignment is simulated by deviating the path of the incoming light. Very simple!
In general, it is very important to get the best possible correction of any refractive error - especially for the better eye. This can be pretty hard because the average standard acuity test involves totally occluding each eye in turn, which can make latent nystagmus a bother. In that case apply one of the "blurring" tricks described later.

..Are prisms fun?

This depends on the required strength. For example, a turned-in eye requires a prism with the thin edge towards the nose. This moves the things you see towards the nose, but also for the people who look at you, so your eye appears to be even more displaced inwards. ("These new glasses of yours only make it worse!" they'll say). This is a disadvantage of a prism made of glass (or plastic). Another type of prism is the Fresnel type - the "lighthouse" sortof lens, manufactured as a membrane. It can be stuck on regular glasses, does the same as any other prism, and people only see weird thin lines across your eyeglasses. Fresnel "stick-on" prisms have bad optical properties though. Just like glass prisms have in the higher strengths. Up to 6 prism diopters you don't really notice the things (either you or an observer), and they can highly effective, but if you happen to need 30 prism diopters it's a whole other matter - aside from distorting the image, everything gets colored edges. Prisms can produce great rainbows, after all.

..Is surgery fun?
Probably never, but it is not a big deal either. It's not like they have to take out whole eyeballs and sew 'm back in. Chances are you'll look like somebody hit you in the eye ("Gee, you've been in a pub fight?") for a week or so. Psychologically it can be rather hard to accept having someone poking a knife around one or both Windows To The Soul, especially for the innocent bystanders like family and friends ("Oh my, eye surgery, how gross! Yuck!). It is said to be no worse than having some dental work done, though. Some people are very nauseous afterwards - the technical reason behind this, is that pulling and tugging at extraocular muscles indirectly sets off the emesis center in the brain. This effect is much less pronouced when local anesthesia is applied, instead of general. When it comes to cost-effectiveness.. surgery is covered by insureance, while mostly glasses with prisms ($$$!) are (mostly) not (In the Netherlands, that is).
A question I received a couple of times is: what do you actually experience and see during strabismus surgery with local anesthesia, and in order to have a properly researched web page I had a close friend try it. :-) It was, reportedly, more fun than the dentist, reminding a bit of "A Clockwork Orange", but actually not very special. Vague silhouets of somebodies hands, blurred lights, some sensation of somebody fumbling around and leaning on your nose, worst part being the separation from your face and the self-adhesive draping sheets stuck to it.

..Are patching or "Vision Training exercises" useful?
Thought I'd include this one because it is quite a "frequently asked question". Whatever you do, don't EVER patch your good eye. Just don't. Amblyopia is there to stay anyway, and you won't gain anything besides perhaps terrible diplopia. Patching is for infants! It will NOT make you "see" the Magic Eye pictures, it is totally useless and certainly not harmless either. Don't even occlude a small part of the good eye (there is this urban legend saying your eyes will "learn how to work together" when you stick a small round dot on the middle of one eyeglass and walk around like that for some weeks) - the results are about as disastrous as any other ill advised patching "therapy". I hope this is clear! Somehow it is part of folklore to associate strabismus with patching, but again, patching the good eye is for kids.
"Vision Therapy" (see for example The Stereo Vision Project ) can be a lot of things; "natural vision", "curing amblyopia", "eye tracking excercises", "3D perception training" - there is probably no harm in it as long as you get this training from someone who is qualified - an optometrist for instance. There is evidence Vision Training works - but if it works for all types of strabismus is not clear. Beware of quacks, there are some businesses out there claiming they can fix your debililtating diplopia, nystagmus, glaucoma, myopia and improve your sense of well-being all in one go, with some unheard-of miracle cure. If these claims were true they'd have won a Nobel prize by now, so this is nothing but clever marketing.

..And if all else fails?
Notice: don't apply any form of patching without getting medical advice first.
When we're talking about unacceptable diplopia, occlusion or "blurring" of the amblyopic (or otherwise least useful eye) is an option. Best occluding device is the good old sailor's patch. Less conspicuous are occlusive contact lenses. There are soft and hard lenses with a black pupil, and lenses with a painted iris and pupil. The ones with the painted iris and pupil are the best choice, but have to be carefully matched with the fellow eye, and are quite expensive. The ones with just a black pupil come in different pupil sizes, and you have to buy one with a larger diameter than your pupil dilates at night, otherwise it'll "leak" all around the edges. During the daytime this makes the difference in pupil size between the two eyes very visible ("Is your left brain on dope or something?"). My experience is limited to the soft lens with painted on pupil, and it wasn't a good one - to start with the thing was more dark grey than black, and in the course of just a week of occasional use it discolored to a transparent blue, and so did a replacement lens, even after having switched to some high tech kind of very expensive cleaning solution. Not just your pupil diameter is an important parameter, also if you have eccentric fixation, it is like the lens is never properly centered, you'll always be looking "around a corner". Furthermore, if you happen to have latent nystagmus, occluding one eye makes that very noticable, it may even be more irritating than diplopia.
"Blurring" the input to one eye can be a viable alternative for some - the advantage being it mostly doesn't provoke nystagmus in the fellow eye. For a blurring device you can use a high power plus contact lens (the actual power needed depends on if and what prescription glasses/contacts you normally wear), a "frosted" eye glass (very ugly), Scotch magic tape on your normal glasses (also unsightly, but highly cost-effective), or a pair of high strength reading glasses (the el cheapo ones from the gas station or drugstore) from which you remove one glass; these can be worn over your regular glasses if needed - if you don't mind looking rather ridiculous. And of course, you can always learn to live with it! ..barf.. (oops, sorry).. or write a WEB page about it.

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A naggingsubconscious begs me to correct this subtle lie: it may be no big deal for most, but lots of people (after strabismus surgery with general anesthesia) suffer from PONV (Post Operative Nausea and Vomiting) A GASNet source describes PONV in a poetic way as: "Nausea is the uncomfortable sensation of an impending episode of vomiting. It is often associated with prodromal symptoms such as salivation, swallowing, pallor and tachycardia. Vomiting is a complicated process [...] The following types of surgery have been found to correlate with a higher incidence of PONV: Laparoscopic (especially gynecological), strabismus, [...]" After strabismus surgery with local anesthesia PONV is very rare.

Speaking about the general anesthesia again, and without any anti-emetic medication, PONV occurs in about 85% of cases, with the most expensive kind of medication (Ondansetron) in about 6%, and with Droperidol in about 20% of cases. Droperidol is the most cost-effective choice for hospitals and most used. However, being one of those 20% of cases, is just bloody awful!