Squint surgery/botox

[UpOnDown]

Hi,

I have an eye that turns out at a large angle (too large for prisms to be successful, so I'm told - they'd have to use prisms built into the glasses and Fresnel prisms on top, so the visual acuity would be very poor). I struggle with close work because I can see through the turned out eye at the same time as ahead of me through the other eye, and can't make out slopes etc. when out and about (important as I'm a wheelchair user).

I did consent to surgery a few years ago, but it all fell through (they kept rearranging for the next day, which I couldn't do).

I saw an orthoptist today, and they suggested surgery again...I asked about Botox, and she said that she'd ask - it might help them see if the surgery would work, as apparently even if they did straighten my eyes my brain might still take the images separately.

She put frosted tape on my less good eye spectacle lens, at the moment it's quite distracting. How is it supposed to help, does it encourage the brain to switch off that eye's image?

How can I decide about surgery if they say no to the Botox? I've had bad surgical experiences in the past, and if it might not help I'm unsure about it.

[CMOTDibbler]

I would have thought it was way too late to do the frosted tape thing tbh. I have had fresnel prisms in the past, and the visual acuity was fine - much better than having double vision certainly!

As a squinter (2 lots of surgery, prisms in my glasses), I'd say if you see double now, surgery would be successful. Its not big surgery, and the botox is unpredicatable and will only last a short time - much less hassle to have enough surgery to bring your eye in enough for prisms

[UpOnDown]

I've had fresnel prisms in the past too - they reduced my visual acuity by one line I think. Perhaps it's because they would be on top of prisms built into the glasses that it affects acuity (I needed 70+ prisms).

Thanks for your surgery experiences! I see a CPN, and she's said she could try to help if they did come back saying surgery is the only option...but I'm still not sure.

[CMOTDibbler]

I can't see how it would make any difference being on top of in lens prisms tbh - and they can adjust your overall prescription as well to compensate as much as possible.

They are pretty good at getting eyes straight in a ball park area (so if you are wearing glasses anyway, some prism is fine), and if your brain hasn't switched off that eye, I think you are in with a good chance. I've had botox therapeutically for a non eye issue, and it was very approximate tbh.

Talk to the opthamologist about it all though, with your CPNs support. They are the expert, and I found orthoptists not very good with adult squints

[UpOnDown]

Thanks CMOT - I've had botox for a different issue too, which was how I knew about it. I agree re:orthoptists, she commented I was the first adult she'd seen all day.

[Corneliussnitch]

Hi Up, I'm an orthoptist. Usually frosting tape is used to stop you seeing double if it is not possible to join the images with prisms. Squint surgery is always aiming to improve the alignment of your eyes but if your eyes have the potential to,work together if straightened it is termed functional surgery as it can also restore or improve your binocular vision. Only a small amount of prism can be built into glasses and fresnel prisms can be fitted in addition if higher amounts of prism are needed, the strongest Fresnel prism is 40 dioptres( 20 degrees) so there is an upper limit to how much they can correct. Fresnel prisms do cause some blurring of the vision and the higher the power of the prism the more blurring there is. Botox can be used to temporarily realign the eye and for a divergent squint they would inject the lateral rectus muscle which is the muscle that moves the eye outwards away from the nose. Botox can often give an overcorrection initially so that your eye would turn in and the effect would gradually wear off. Botox is often a good choice for people who do not want or are not suitable for squint surgery or have already had lots of previous squint surgery. An orthoptist should know a great deal more about squints than an ophthalmologist both in adults and children as it is what we specialise in. You may have been unlucky in orthoptists you have seen, but Imcertainly see as many adults as children and work in a tertiary referral centre for adult squint patients

[UpOnDown]

Gosh cornelius, thanks for your full and frank answer! It's good to hear from a professional! I've had fresnels on the past, but without full correction.

[UpOnDown]

Ps the orthoptist did seem knowledgeable