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!

Susanna, the One Eyed Princess

Susanna was born with strabismus in the former USSR. The photo below is “of me in 1979 in Russia with a play phone, where you can see that my eyes were really crossed,” she writes. Susanna is a speaker, world-traveler, writer, and more. I’m fascinated with all Susanna is accomplishing in spite of her strabismus, and I asked her to share her story with us. Susanna writes:

Susanna in Russia, 1979In the Soviet Union, where I was born, doctors didn’t operate on strabismic babies or toddlers to straighten their eye muscles. But because my two divergent eyes made me look so weird, I went to a daycare for retarded and mentally handicapped children although I was not retarded.

My 1st surgery was at the Jewish Hospital (now called Barnes Jewish) in St Louis, Missouri, when I was three years old. After the surgery, I had a lazy eye which was straightened when I was 17 at Kaiser Santa Clara Hospital in California. It was a huge relief to me to wear contact lenses and have straight eyes. People stopped looking at me funny. I could tell when people weren’t listening to what I was saying because they were too busy trying to figure out which eye to look at. In 2006, I read the article, “Stereo Sue” by Dr. Oliver Sacks, when I was surprised to find out that I didn’t see like most other people. Prior to finding out about Susan Barry, I didn’t know that there was something called depth perception and that I didn’t have it. Finally, I had an explanation for why I was bad at parallel parking and merging traffic.

When I asked my optometrist who was fitting me for contacts if it was true that I couldn’t see in 3D, he looked at me funny and said, “Really, you didn’t know?”. He seemed to think it was no big deal as his aunt couldn’t see the tree outside of her window. I’ve been to over 50 countries. I’ve seen Macchu Picchu. I’ve been to the Coliseum. If there’s another dimension of life to which I am blind, I most definitely want to see it.

After reading “Fixing My Gaze” by Susan Barry [see below], it took me another year and a half to commit to vision therapy. The financial impact of paying for it on my own, as my insurance would not cover it, was the most important barrier. But as soon as I embarked on my journey to 3D, I encountered major psychological stumbling blocks during vision therapy appointments and outside the doctor’s office.

I am a traveler and adventurer by nature, but his road to 3D is the most difficult journey ever. No sign posts, no express bullet trains, no maps. Just hard work every day. And faith. Man, this takes a lot of faith in the power of the brain to change. I speak seven languages and have written books on learning language through music and the media and budget travel. Vision therapy is harder than writing books, learning languages or traveling in former war zones. It’s a journey through the mine fields of my brain and past struggles with being cross-eyed.

I created my blog, One Eyed Princess, to document the trials and tribulations of doing binocular vision therapy as an adult because I needed an avenue to express myself. Few people around me could understand why I was suddenly getting tired or had trouble driving at night. The blog was and is a form a catharsis and a way for me to reach out to other people going through the same thing.

Please feel free to visit my blog: http://www.oneeyedprincess.com and comment.

Photos of rectus eye muscle strabismus surgery in progress

photo of scalpelI’ve been asked several times if I know of any photos on the net of strabismus surgery in progress. I came across these photos a few weeks ago. I’ve been hesitant to publish them, because while it may help relieve fears for some to see what is actually being done, others facing the surgery may be traumatized by the photos.

These full size images may disturb you. You can see an illustration rather than an actual photo of strabismus surgery at EyeMDLink. You’ll need to scroll a little past half way down the page to see the graphics.

View the small photos first. If you want to see the larger photos, you can see them by clicking corresponding small photo.

Isolating the inferior rectus muscleThe left photo is entitled Isolating the inferior rectus muscle. There is no further explanation offered for it.

Disinserting the medial rectus muscleThe right photo is entitled Disinserting the medial rectus muscle and here is the explanation that is with the photo:

medial rectus muscle being disinserted following pre-placement of vicryl sutures. A Castroviejo locking forceps is grasping the superior pole of the muscle, while a Manson-Aebli scissors does the cutting. The eyelids are being held by a Cook speculum.

Photo credits:
Scapel by Chris Gander; Isolating the inferior rectus muscle, provided by Rakesh Ahuja, MD, under Creative Commons License through Wikipedia.; Disinserting the medial rectus muscle: Wikipedia

Seeing beyond strabismus

Open window with curtainWhen I updated my post-surgery status on April 12, things weren’t looking very good, literally. My January 12 strabismus surgery had originally taken me from a torsion to near perfect vision. But my vision had deteriorated over the next few weeks, leaving me with a hypertropia, and my eye/brain connection couldn’t keep up. It was very difficult for me to do anything that required me to focus at close-up. My vision was worse than it had ever been.

But that was before the latest set of events. I could not keep up at work because of my deteriorating ability to focus, and my boss started seeking a replacement for me in mid-April. They allowed me to stay on until my replacement could be found and trained. My last day at my job was June 15. As things slowed down at work for me, my eyes were not as strained. I also got some new prism glasses that made a huge difference. Lastly, I had a sleep study done and am on CPAP for my sleep apnea now, and that has helped my eyes also.

I’m doing much better as long as I don’t overuse my eyes. I still have to stop and let them rest often. I have also developed some shortness of breath with activity related to an old injury (that’s also causing my sleep apnea), so it works out pretty good. I work on the computer until my eyes get tired, then I work on projects around the house until I get short of breath. By then my eyes are rested enough to go back to the computer for awhile!

I’m looking at work possibilities, and what I may be able to do to provide income. I’m planning to do some things from home to earn income for now. I’m also doing vision therapy from home now. Meanwhile I’m very thankful for the improvements in my vision and my relief from sleep apnea!

Photo credit: Dolamore

Fixing the inner problem of strabismus: which direction is best?

Eunice from Singapore writes:

arrows pointing in opposite directionsHi, Greetings from Singapore. I am very worried about my son age 3+ now, his eyes is always drifting away when he’s tried or ill. I guess that called Strabismus, right ? Any cured or treatment for him, he’s so young at age. i consulted a eye specialist , he suggest operations to aline the eyeballs, but i am much worried its just a cosmetic appearance and the inner problem not sloved, please advise.

Eunice, this is the difficult question those of us with strabismus face. Many of us have felt very alone as we struggled with which way to go. Thankfully we are finding each other now on places like Eyes Apart. But it is still confusing because eye care professionals don’t agree on what is the best treatment for strabismus.

The thinking behind aligning the eyes as perfectly as possible by surgery is that it enables the brain to direct them together as a unit more easily. On the other hand, doctors who treat strabismus with special exercises (vision therapy) believe that the solution is re-teaching the brain how to direct the eyes. There is lots of controversy about these two most popular treatments for strabismus.

The one thing most everyone is in agreement on is that treatment needs to start early. If treatment can be provided when a child is young, before his or her vision patterns have matured, it is easier to establish correct vision.

You can talk with people who have strabismus or other parents who have faced similar questions in our email support group. See Eyes Apart Strabismus Support Group for more information.

Photo credit: G?zde Otman