Question: please could you advise if the following is our best way forward
XXXXXXX aged 6
Her condition - Accommodative Esotropia can be controlled (not cured) partially or fully with glasses alone. Her high hyperopia or far sightedness causes blurred vision. This blurred vision will stimulate her eyes to start focusing however in her condition, when she focuses her eyes converge in. With glasses, since you are correcting the error, her eyes does not need to exert effort to focus and hence there is less or no deviation anymore. The strength of the Right eye is the same +5.00 while the left went up by 0.75 from +5.75 to +6.50 this is not surprising at all. Changes from 0.5-0.75 are not significant. Her deviation measures 50 Prism Diopter without the glasses and this goes down to 16-18 Prism diopter with the glasses. Therefore there is still a little amount of crossing left with her current glass so I gave the new prescription first and will have her evaluated if that +0.75 change on the left will help align. Her eyes will not align on its own, again the glasses will just help in the control but if we really want it aligned, it will be strabismus surgery. There is really no urgency in doing the surgery but that is the only solution if we really want alignment.
Muscle surgery/Squint surgery or Strabismus surgery is an out patient procedure. It will normally take an hour to 1 hour and a half. For children, it will have to be done under general anesthesia. Adults can do it under local anesthesia. In Jessica's case I will need to move the inner muscles of both eyes backward for her eyes to straighten out. There are no cuts in the skin. The muscle is only 5-5.5mm away from the colored portion of the eye and easily captured with a muscle hook. I will then place an absorbable suture on the muscle, remove it from the original insertion then re-suture it posteriorly or further back to allow the eye from its inward position to move to the center.. The eyes will be red in the inner corner after surgery -- pretty much like a pink eye which will spontaneously resolve over a few days to a few weeks. She will be on anti-biotic and anti-inflammatory drops as well for a week or 2. Most kids recover fast. The risk of infection, anesthesia complications, allergies to suture are very low. There is a possibility of under correction which means that without glasses her eyes will still turn in but not to the same degree as what she has now. This may correct on its own later on when her refraction starts to go down.