Suggested list of questions for your strabismus surgeon

Blue question mark
Blue question mark, public domain.
George Alexanian recently provided our Eyes Apart Strabismus Support Group with a list of questions he recommends for you to ask your strabismus surgeon. He did a great job with the list in the group, and has since refined it further. George graciously allowed me to post the list here so it can be easily found by group members as well as those visiting our Eyes Apart blog. George writes:

I am not a doctor and have no medical training, so I can only make these recommendations from my experience as a strabismus surgery patient. On the first consultation, I would ask the questions which will give you confidence in this surgeon, but only ask if he has not already answered them. Tell him that if he does not mind, you have some questions to put your mind at ease:

  1. How long have you done adult strabismus procedures, and how many have you done and with what success?
  2. What is my eye deviation in diopters?
  3. What is the largest diopter deviation you have done successfully? (Mine was 50.)
  4. How old was your oldest patient? (Only if you are older than 50-I was 63.)
  5. Do you see any potential complications in my case? (previous scarring, astigmatism, etc.)
  6. What percentages of your patients have eyes that have not drifted for at least five years?
  7. Will you get insurance approval for me? If the insurance will not cover it, what is my total out of pocket cost? (He may refer you to the person who handles scheduling, insurance approval, and payments.)
  8. Could I get a couple of recent patient references?

Once you have decided on this surgeon, then during the second visit or pre-op, I would ask:

  1. Do you recommend cutting muscles in both eyes or just one eye if the other is straight? (My surgeon held my straight eye in position while cutting two muscles in my deviated eye, but most will recommend doing both eyes for best results and reducing chance of double vision.)
  2. Do you recommend adjustable sutures or fixed sutures? (I had fixed, but most will recommend adjustable also for improved appearance and reduced chance of double vision.)
  3. How much greater are my chances of a successful procedure with adjustable sutures and doing both eyes at one time?
  4. How many muscles will you reposition in each eye?
  5. How long will the actual procedure take? (about one hour for me for one eye).
  6. What is the recovery time with adjustable and fixed sutures? (Adjustable will take longer with some discomfort,) and how long will I be out work or school? (In my case, I went to work two days later, but I am the boss and have a desk job.)
  7. Do you use the same anesthesiologist for all your strabismus procedures?
  8. What do you consider a successful procedure (How many diopters deviation and no double vision?)

You may have other questions, but the above are the most important in my mind.

In my case, in 2005, the surgeon scared me out of it with her recommendation of having to do both eyes, possible infection, over-under correction, and double vision, along with the possible complication due to scaring from a similar 1956 procedure. So I procrastinated until 2008. When all this possible negative stuff comes out, remember that this procedure has been around since the 1950’s (I had my first one in 1956 in France), so it is very common by now.

George Alexanian’s “Suggested list of questions for your strabismus surgeon” is Copyright by George Alexanian and Eyes Apart, and may not be used without written permission.

George has been helping people at Eyes Apart for a bunch of years now. We appreciate him so much. George “adopted” the My Strabismus Surgery area of Eyes Apart and provides excellent support for those considering or recovering from surgery. George also helps people via our email support group.

You can click the “older comments” link at the bottom of the My Strabismus Surgery page to see more comments, including George’s very helpful and encouraging responses through the years. Thank you, George, for all you do!

Stereogram: Find the unattached ring that is not a circle

Stereogram: Unattached Ring
Courtesy: Sylvain Roques
Can you find the unattached ring that is not a circle? Click the thumbnail to try this stereogram, then use the back button in your browser to return to this page (see Caution below).

View a 3-D stereogram image by allowing your eyes to cross or drift while maintaining focus directly between the two images, until you see four images that merge into an unfocused third image in the middle. While maintaining your focus on the middle image, continue to relax your eyes until you can see it clearly.

The Unattached Ring stereogram is a more difficult one. If you are new to stereograms, try this cat card first. You can enlarge it by clicking the image at the destination site. This is exactly like the cat card my COVD doctor gave me to begin with. It took several weeks of effort before I could put the cat together in the middle. If you are have difficulty with this, it is especially important follow the Caution below.

Caution: My COVD Developmental Optometrist prescribed similar vision exercises for me. However, vision therapy is not a one-size-fits-all. Several COVD Developmental Optometrists have told me that doing the wrong exercises for your specific needs, or doing them incorrectly, can be harmful. If you have strabismus, you should ask a physician trained in Developmental Optometry (which includes Vision Therapy) which types of eye exercises are safe or beneficial for you before attempting this exercise. Click the COVD link or the Find a vision therapy dr. link in the sidebar to locate a Developmental Optometrist in your area.

Emo-amblyopia controversy: Can Bieber fringe bang cut cause lazy eye?

Emosmile, courtesy Lockal. Click for info.
The emo-amblyopia controversy began when leading Australian Optometrist Andrew Hogan said, “If a young emo chap has a fringe covering one eye all the time, that eye won’t see a lot of detail…and if it happens from a young age, that eye can become amblyotic.” Dr. Hogan, serving three years as President of the Optometrists Association, and currently sitting on the National Executive, continued to explain, according to TheMercury, that the most vulnerable time for this to happen is before age seven, but he said new research shows vision could be affected even later.

At least two Australian newspapers reported the story, apparently originating on May 13, at or near midnight on May 14. Australia’s TheTelegraph published No fringe benefits for hairstyles that flop over one eye on May 14, 2012, at 12:00am, and Tasmania’s TheMercury released its Trendy hair may be a hazard one minute later, at 12:01am. The story spread quickly as The Huffington Post and other news media picked it later that day.

The pot was stirred when New Jersey Optometrist and co-author of the clinical practice guidelines on amblyopia for the American Optometric Association, Dr. Leonard Press, spoke with MSNBC’s The Body Odd reporter Brian Alexander. Dr. Press said, “The story would only be true if you had somebody young enough, and if that person never looked out of that eye — if it was blocked 24-7. The reason it’s false is that you don’t have that constant deprivation.” MSNBC reports that, according to Dr. Press, “the visual system ‘is so well-established’ after childhood, that ‘combing your hair over your eye will not do anything to that system.’”

The story received attention to an even more wide-spread audience when ABC’s Good Morining America featured it on May 16, asking if Justin Bieber’s haircut causes lazy eye.

Emo originated in the mid-1980’s with the hardcore punk movement of Washington, D.C., where it was known as “emotional hardcore” or “emocore,” but it didn’t break into the mainstream media until the summer of 2002, according to Wikipedia. “Today emo is commonly tied to both music and fashion,” Wikipedia explains. “In the early 2000s, emo fashion was associated with a clean cut look, but as the style spread to younger teenagers, the style has become darker, with long bangs.”

It is these long side-swept bangs that are at the heart of the current emo-amblyopia controversy. I’ve seen an occasional person paw their dangling locks away from their eyes as far back as I can remember, but the trend to peep through sweep fringes has never been as consistent as it is among many young people today. It will be interesting to see the outcome of these two opposing professional opinions, both from well-respected Optometrists, for which only time can give a certain outcome.

Dry eye syndrome: where are my tears?

Water dropAbout 12 million Americans suffer from dry eye syndrome according to WebMD. If you, like me, are one of them, you know how uncomfortable this can be.

According to a WebMD report, “Tears are a combination of water, for moisture; oils, for lubrication; mucus, for even spreading; and antibodies and special proteins, for resistance to infection.”

Oils and fluids from the meibomian glands in our eyelids keep our eyes moist. If our meibomian glands fail to produce or secrete these oils, we experience dry eye symptoms. It’s thought that the high-fat diet of our culture thickens these fluids, making it difficult for them to be released from the meibomian glands. Reseachers believe Omega-3 fatty acid from fish oil and possibly flaxseed oil helps soften these secretions, enabling them to flow freely from the meibomian glands.

Flax seeds
Flax seeds

Studies indicate that the fatty acids EPA and DHA found in fish may reduce the risk of macular degeneration. However, the University of Maryland Medical Center (UMMC) says a recent study indicates that the fatty acid ALA found in flaxseed oil may substantially increase the risk of macular degeneration. UMMC warns, “More research is needed. Until then, people with macular degeneration should get omega-3 fatty acids from sources of EPA and DHA (such as fish or fish oil), rather than ALA.”

There are other contraindications and drug interactions for flaxseed oil as well. You can read about some of these in the links below below. You should ask your doctor if it is safe for you before taking any supplement. For more info, see:

WebMD: Flaxseed Oil Supplements May Help Dry Eyes

UMMC: Flaxseed Oil

Foundation promotes strabismus education, brain tumor awareness

Tiffany Johnson
Tiffany Johnson, Founder and CEO of "Your Eyes Are Your Heart, Inc."
What do you get when you cross a brain tumor fighter with strabismus? You get Your Eyes Are Your Heart founder and CEO, Tiffany Johnson. Tiffany grew up an only child in Brooklyn, New York. Even as a child Tiffany dealt with vision problems. She visited the ophthalmologist as scheduled and was always told to wear reading glasses. As Tiffany entered her teens, her doctor began to notice she had a droopy right eye lid.

In 2002, at the age of twenty, Tiffany moved to Richmond, Virginia, where she pursued an undergraduate degree at Strayer University. On her first visit to the Virginia Eye Institute in Richmond, doctors noticed her right pupil did not dilate and they saw a tumor on her optic nerve. Everything she had started was about to come to a halt when they told her she had a brain tumor and needed treatment as soon as possible. After weeks of testing, the tumor was found to be a benign pituitary brain tumor, and Tiffany was advised to begin Gamma Knife treatment that consists of brain surgery and radiation. The Gamma Knife procedure was successful at shrinking the tumor but it would be there for the rest of her life. A year after the procedure her right eye started to turn inward, and she was told she had a condition called strabismus.

Having now lived with strabismus for many years, Tiffany knows firsthand the misconception of the condition. She has dealt with self-esteem issues. “Having strabismus, people tend to give a lot of probing stares that make you feel uncomfortable,” Tiffany writes. She began to wonder how anyone could love a person who looks like her. She stopped looking people in the eye because she was afraid of people judging her.

Today Tiffany continues to do research about brain tumors and strabismus so she can help herself and others. Thanks to her doctors, teachers, family members, and friends, she was eventually able to see what they see–how beautiful she is beyond her eyes.

Your Eyes Are Your heart, Inc.Tiffany Johnson established the non-profit Your Eyes Are Your Heart Foundation to assist families who face the same challenges she has with the brain tumor and strabismus. She believes through research and fundraising, “we can make a big difference in people’s lives. We focus on treatment, vision therapy and self-esteem programs for youth and adults dealing with the probing stares and questions about strabismus,” Tiffany writes, “and we bring awareness to brain tumors. We believe our programs we will give back to our community through health, education and nutrition.”

To learn more about Tiffany Johnson and Your Eyes Are Your Heart programs, visit Your Eyes Are Your Heart, Inc.. You can also visit Your Eyes Are Your Heart, Inc. on Facebook. Tiffany also has a Facebook group: I’m living with strabismus-How to love your eyes for life.