Squint surgery frequently asked questions

squint

Is strabismus surgery the only treatment option?

No. Strabismus treatment options and outcomes vary considerably based on the type of strabismus and other factors, such the presence of convergence insufficiency, double vision, or amblyopia (lazy eye). Non-surgical treatment is available and more likely to lead to improved vision.

Treatment options involves :

  1. Surgery for strabismus and lazy eye.
  2. Orthoptics: is the medical term for eye muscle training procedures. Orthoptics regards strabimus as an eye muscle problem and treatment is directed toward muscle strength. In general, orthoptics is home-based therapy. Recent scientific research has shown that office-based Vision Therapy with homework is more successful than home-based therapy alone.

Will eye muscle surgery help me or my child?

Your brain directs and controls your eyes and eye muscle surgery is not brain surgery. Cutting and moving the eye muscles will not automatically change the brain or the signals it sends to the eye muscles. This is why patients’ eyes often “go back” or deviate again after surgery. Frequently, then, the surgeon recommends a repeat surgery. It is important to understand that while eye muscle surgery can improve cosmetic appearance, it does not necessarily improve eyesight or vision.

Numerous peer-reviewed scientific studies report success rates for eye muscle surgeries ranging from 30% to 80%. In those studies, the success is sometimes defined as cosmetic improvement only. “Cosmetic improvement only” means that, following the eye muscle surgery, the patient’s eyes maintained a straight and aligned appearance, but improved vision was not achieved.

For example, one scientific research study (Flax and Duckman, Orthoptic Treatment of Strabismus, Journal of AOA, 49th edition (12) p. 1353, 1978) reported a 50% success rate as a result of surgical treatment only for strabismus. In that study, success was defined as ANY long-lasting positive benefit, including cosmetic improvement only [to repeat, as explained above, cosmetic improvement only means outside appearance improved, the patient’s vision did not].

Clearly, it is important to determine whether surgery is being recommended for the purposes of cosmetic improvement only. Ask the surgeon to be explicit regarding the goals and risks associated with any surgery. Parents are encouraged to ask many questions. Ask about expected outcomes. For example, ask whether the surgeon expects the eyes to work better as a binocular (two-eyed) team as a result of surgery. You should know the possibilities regarding better appearance (cosmetic cure) and/or better vision (a binocular cure). Also, do not forget to discuss the likelihood that multiple surgeries will be recommended.

How many surgeries?

If your surgeon has recommended initial eye muscle surgery, ask how many surgeries! The surgeon should be very clear as to the possibility that repeat surgeries will be recommended down the road.

…comments from one of our visitors:

 

Normal Appearance vs. Normal Vision
(Cosmetic Cure vs. Binocular Cure)

In regards to a cosmetic cure, the parent or adult patient needs to be informed in advance that good cosmetic alignment is often not achieved until two or three surgical procedures are performed. Regarding the gaining or recovery of normal vision (binocular cure), the parent or patient needs to know that if — following surgery — the two eyes are almost straight but not perfectly straight, then they still can not work together. This is important to keep in mind when the surgeon says a child needs strabismus surgery. Ask him/her if she/he is going to make the eyes look better or work better together. You should know the chances of cosmetic cure (normal appearance) vs. a binocular cure (normal vision).

Pre- and post-surgical treatment

Surgery which does not achieve perfect alignment yields cosmetic improvement only. Effective surgical intervention to gain the use of both eyes requires not only perfect alignment but also an eye doctor who knows how to stimulate the two eyes to work together with lenses, prism, and Vision Therapy. This is why we recommend pre- and post-surgical consultation with a developmental optometrist.

Surgery, if necessary, should be coordinated with the developmental optometrist who is knowledgeable in visual development if the goal is for improved vision or binocular vision. During the critical period, if therapy is not initiated immediately following surgery, the chances of success diminish. Pre-surgical consultation and stimulation by the optometrist are also helpful.

Does the age of the patient matter?

Age has an impact on whether surgery is appropriate. For example, early occurring CONSTANT strabismus is the one type of strabismus which might need early surgery to eliminate the eye turn.

For other types of strabismus (especially, sudden strabismus), by all means, don’t allow a surgeon to rush you into surgery based on statements about age. In all cases, we recommend that you seek a second opinion.

It is best to have a behavioral optometrist [developmental optometrist] be the captain of the ship. Often, surgeons are concerned only with the cosmetic appearance and do not provide all treatment options, such as Vision Therapy. Optometrists are more likely to be concerned with obtaining functional binocularity that requires the use of Vision Therapy.