Adult Strabismus & Diplopia

Never Too Late to correct Adult Strabismus

Children’s Eye Care offers life-changing treatment options for Adult Strabismus

As eye care professionals, there are few things more rewarding to the ophthalmologists of Children’s Eye Care of Michigan, than witnessing the emotional impact of adult strabismus correction. For many of the approximately 1,000 adult patients with strabismus who come through the doors of Children’s Eye Center of Michigan each year, they have spent decades living with a “lazy eye.”

The personal and professional repercussions of strabismus have shaped many facets of these patients’ lives – quite often in a negative way. In fact, research has shown that individuals with eye misalignments are less likely to secure quality employment and more likely to experience difficulty with interpersonal relationships and social anxiety.

“Our patients with eye misalignment regularly say that people don’t know which of their eyes to look at,” Dr. Rajesh C. Rao notes. “So they avoid eye contact altogether.”

What the strabismus experts at Children’s Eye Care of Michigan desperately want optometrists, ophthalmologists and general medical care providers to know is that they can refer their adult patients with strabismus for treatment. It is never too late for this life-changing correction. In fact, the Children’s Eye Care of Michigan team has treated patients with eye misalignments who are well into their golden years.

With viable treatment options available that not only will align the eyes but potentially enhance depth perception and even improve peripheral vision, it can be difficult to understand why patients don’t always pursue treatment. According to Dr. Rajesh C. Rao, it’s often due to lack of proper information.

“Of all the eye conditions I see, adult strabismus is the one most misunderstood,” Dr. Rajesh C. Rao notes. “There is a lot of misinformation out there coming even from other physicians and other eye care providers.”

Dr. Rajesh C. Rao says a common misperception is that if an eye misalignment isn’t corrected during childhood, that it can’t be. Another myth is that correcting the eye misalignment will result in double vision. The truth is just the opposite.

The Children’s Eye Care of Michigan experience

Adult patients with strabismus who are referred to Children’s Eye Care of Michigan are often surprised to see a waiting room occupied with many other adult patients. Dr. Alexandra. O. Apkarian, Dr. Lisa Bohra, Dr. Elena M. Gianfermi, Dr. Amanda A. Ismail, Dr. Rajesh Rao and Dr. Leemor B. Rotberg devote some of their clinic time to seeing strictly adult patients with strabismus.

“Many of our patients appreciate not being the only adult in a waiting room full of kids,” Dr. Leemor B. Rotberg notes. “While it may say ‘Children’s Eye Care’ on the door, we see many adult patients with strabismus and try to schedule them on the same days.”

After an initial exam with an AACO certified orthoptist, which entails various eye measurements, a patient will meet with one of the strabismus surgeons of Children’s Eye Care of Michigan who will conduct his or her own exam and develop a plan of treatment.

“If the strabismus is not large, the treatment may simply involve the use of prisms built into a patient’s eyeglass lenses,” Dr. Gianfermi explains. “Many adults are treated in this way and never require surgery.”

For individuals with a larger strabismus, the doctor may recommend outpatient surgery to loosen or tighten one or more of the six extraocular muscles that control eye position. The ultimate goal is for both eyes to move together and work together. On average, a surgical procedure to correct strabismus takes approximately 45 minutes, and the results are apparent immediately following surgery.

“There will still be some healing time required, but the alignment correction is immediate,” Dr. Rajesh C. Rao says.

When patients first have a chance to look at their eyes in the mirror post-surgery, it’s not uncommon for them to experience tears – of joy.

Surgical patients will need to follow up with their strabismus surgeon at Children’s Eye Care of Michigan within five weeks of surgery, but are then encouraged to return to their usual eye care provider.

“Unless there are any changes to the eyes’ alignment, patients don’t need to come back and see us,” says Dr. Rajesh C. Rao who acknowledges that a small minority of patients may need a second procedure.

Not a “vanity thing”

Children’s Eye Care’s orthoptist Mary DeYoung-Smith, CO, COMT can recall seeing many patients with adult strabismus who have hesitated to pursue corrective treatment viewing surgery as cosmetic in nature.

“That couldn’t be further from the truth,” she says. “Cosmetic is when you’re enhancing something that’s already normal. Your eye drifting outward is not normal.”

And to referral sources who consider strabismus correction cosmetic, Children’s Eye Care of Michigan’s doctors point to the visual, emotional, and social benefits documented to scholarly publications. Every insurance carrier recognizes these benefits and covers the procedure.

“To insurance companies, this is never considered elective surgery,” Dr. Elena M. Gianfermi notes.

The ophthalmologists and orthoptists of Children’s Eye Care of Michigan never fail to be moved when a patient who has dealt with strabismus for years looks into the mirror for the first time and sees two straight eyes looking back.

“It’s hugely emotional,” Dr. Rajesh C. Rao says. “Very quickly they become more confident in the way they interact with people. They truly feel better about themselves.”

Helping us to help them

Dr. Rajesh C. Rao and team note that once patients know there are viable treatment options out there for correction of an eye misalignment, they typically jump at the chance to correct the strabismus.

“The bigger issue is to educate patients and potential referring physicians that there is a fix, and to encourage physicians to bring it up with their patients,” Dr. Rajesh C. Rao says. “Even if a patient has had a misalignment for years and isn’t voicing anything about addressing it, it’s incumbent upon providers to inform patients of their options. Chances are their patients simply aren’t aware that there is very real hope.”

To learn more

For more information about adult strabismus correction in Michigan, call us at 866-338-3937 to schedule an appointment in our Clinton Township, Dearborn or West Bloomfield office.

Children’s Eye Care provides this information for general educational purposes only. It should not be construed as personal medical advice. Information published on this website is not intended to replace, supplant, or augment a consultation with an eye care professional. Children’s Eye Care disclaims any and all liability for injury or other damages that could result from use of the information obtained from this site.

Diplopia

When an individual sees two things or two images of the same thing, they complain of seeing double and the medical term is diplopia. In order for the brain to see two things or two images of the same object, the eyes are not straight and each one is looking in a different direction. This misalignment of the eyes may be the result of an injury to the brain, a tumor, diabetes, an infection, injury to the muscles of the eye or injury to the bones around the eye. The result is eyes that are misaligned and not looking at the same object at the same time. Sometimes the eyes are straight when looking in one direction, but because of a nerve or muscle weakness they are not straight when looking in another direction and the patient sees double in that direction.

No matter what the cause, the eyes are not straight when diplopia is present and the condition is very difficult for the patient to deal with and function.

If the misalignment is small, prisms can sometimes be used to produce an alignment of the eyes so that they are both looking at the same thing and eliminate the double vision.

If the misalignment is larger or if the eyes are misaligned a different amount when the patient looks in different directions, then eye muscle surgery is the only way to re-establish ocular alignment and attempt to eliminate the double vision or diplopia.