KR: I am 64. I first noticed there was something wrong with my vision about 5 years ago.  The first symptom was slight double vision in my right side gaze. I mentioned it to my ophthalmologist and she was not concerned at that point. We would keep monitoring it during my annual checkups. It gradually worsened but did not affect my daily life. Three years ago she sent me to a strabismus doctor (strabologist) so we could keep track of the progression. I was diagnosed with age-related decompensating esodeviation.

ML: Did you have strabismus as a child and did decompensate 5 years ago? Or is this a completely new phenomenon?

KR: No, I never had crossed eyes as a child. The doctors I have seen have different opinions on its origin. One thinks I have always had it but I have compensated for it. Another one thinks it’s a long standing problem, but says there is no way to know when it started. I have had numerous neurological tests done and they have all come back negative. Ultimately they think this is age related and my brain just isn’t compensating like it did when I was younger. I have worn glasses most of my life for nearsightedness and with them I have 20-20 vision, so the strabismus is very frustrating.

ML: Yes, it could be possible that you had a certain weakness when it comes to moving or, more specifically, diverging your eyes in certain directions and you compensated for it with more effort. As you age this might have become more difficult.

Initially the only problem was my right gaze being double but as the years have passed the double vision has worsened. It is now to the point that it interferes with my daily activities, especially if I have not slept well or have been on the computer for hours. My morning straight on vision is good, but by afternoon my eyes will not focus, especially on moving objects such as cars. Also, my near vision is always good, this only affects my distance vision. I have seen 3 strabismus doctors in the Dallas, TX area and all of them have recommended surgery on the medial rectus muscle of my left eye.

One doctor did want me to try prisms, so I had glasses made last year. I only wear them when I am driving and actually need them which is maybe 25% of the time.  I’ve been told if you use prisms daily your brain will get used to them and not try to compensate on its own. The eye doctors say, once my eyes (and visual system) get accustomed to the prisms, in time the prisms will have to be made stonger until eventually I’ll need the surgery anyway.

ML: Yes, that is a common response. Take the passive approach until things get to a point you supposedly need surgery either way. I’d say, given the recent onset and the fact that your near vision is not affected (so your vision is not uncomfortable in all circumstances), the prognosis for undergoing Vision Therapy is quite good.

KR: One of the doctors had started me on computerized vision therapy at home in 2014. It was the Computerized Vergence System by Jeffrey Cooper and Rodney Bortel. The VT exercises helped for the first year or so, but now don’t seem to be working so well anymore. There are several different exercises within the system. Unfortunately the doctor who perscribed these has never told me which ones would be best for my specific eye (vision) condition.  As my progression has stopped and I feel like I am visually regressing, I decided to look into what other options are available to me. All doctors’ first suggestion is the surgery which I know can be very successful, but the outcome is also very uncertain. That’s why I am so hesitant to do it.

ML: I think you are on the right track. Eye muscle surgery, especially if your vision has worked well up until fairly recently, is a very high risk option with possibly irreversible side effects. It’s worth exploring more conservative options. The Vision Therapy exercises you did were a good start but you might need more specific and more elaborate guidance. Vision Therapy is more than just computerized exercises. Vision is highly integrated with general movement and the vestibular organ which requires more dynamic exercise with the appropriate visual controls. I propose you look for a good behavioral/developmental optometrist in your area who will help you explore this option to the fullest before resorting to surgery.

KR: I am seriously considering the surgery since my daily life is being affected. Nonetheless I would really like to get a professional opinion on the possibilities of Vision Therapy before proceding to eye muscle surgery. I will look for a behavioral optometrist’s opinion.

 

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