Have you had botox treatment to correct a squint? Am confused about needing new glasses and how to manage changes to vision

[stumbledin]

I am due to have botox treatment for a squint in my right eye which has been getting progressively worse over the past 10 years or so.

Treatment has been postponed twice but as far as I know will go ahead next week.

I have not been able to get any clear guidance on how I manage the change to my eye sight. Not having a squint would be great, but i understand may only last a few months.

Added to which I wear varivocals to help vision long distance but also for reading.

I dont understand how I am meant to get around safely whilst I wait for the botox to work, and then get a new eye test? wait for new glasses to arrive? And if the botox wears off over 3 monhts or so, will I need to get another pair of glasses until I am back to the prescription I am now??!!

Consultant just mumbles about optician, and in fact on google, no leaflets address this reallly fundamental and practicial problem.

So if you have had this treatment would really appreciate any tips or suggestions on how you managed.

Many thanks.

I have searched for previous posts on this and found about 5 in the past 10 years.

In a couple of them people have said they are due to have botox, but never came back on their thread to say what happened, was it worth it?

Makes me wonder if it cant be that useful because wouldn't people who had had the treatment and it had helped want to come back and tell others about it?!

ex dispensing optician here...so specs and lenses side rather than eye exam

What is your visual acuity like in the eye with the squint? Often long standing squint issues mean the quality of vision can be poor, this may not be an issue in your case.
Do you have any double vision?

Patients can sometime get away with a "balance lens" in the affected eye, which does not necessarily need to be a varifocal, you would just be matching the other one for approximate power/weight /tints/coatings. This depends really on how well your eyes work together, if at all.

Sometimes prism lenses can be prescribed to balance/correct the deviation of the image the eye gives to the brain, this might be something you already have, or it may change drastically after the squint correction. This prism element can be worked into the lens, or, if it is likely to be temporary or changeable you can have a stick on option called a Fresnel prism.
Rarely a frosted lens may be required to prevent double vision issues

Anything to do with one eye is always a bit of a nuisance as you do not want to update your specs too soon in case your prescription is still settling or likely to make a big change, so sometime soldiering on with your old specs for a bit is a necessary evil until the consultant signs you off, iyswim

You are going to be in limbo for a while tbh there isn't usually a quick fix until results have all settled...as I said though, I am the dispensing side, not the ophthalmic side, so my advice is strictly glasses!

What does your optician say about it all...who referred you and what are they expecting the outcome to be?

@LaurieSchafferIsAllBitterNow

oh wow - a real life professional.

to try and cut long story short I grew up with what turned out to be progressive myopia. Last reading was -19 in both eyes.

But when I had cataract surgery this was largely corrected.

But in the ten years or so since then my right eye has drifted in towards my nose and with each new prescription was told I was near the limit of prisms that could be made with varifocals. And in fact (although I found this out later having spent hundreds on lenses ground in Germany) I should probably have "tri-focals" as the squint is worse for long distance than close up. Also because it is only one eye they have split the prism between both eyes?? I dont know what this means but in on year it went from 9 prism in both eyes to 11. (which given the 10 years implies a change of 1 each year.(?)

I have some other eye conditions that mean I have been attending eye clinics to monitor the health of my eyes (not at THE well known eye hospital who totally messed me around). And I think it is as much each consultant wants to been seen to do something! Because of how short sighted I was they dont recommend an operation. But seem to think botox the obvious choice as the squint keeps getting worse.

I suspect if I wasn't reliant on my local NHS optician and could afford a more specialist one (eg prescribing and fitting tri vocals) I wouldn't bother with the botox.

Its partly practical. ie I cant afford to be unable to get around safely while new glasses are made, nor in fact have say a range of glasses made up with varying strength of prism if over 3 months the eye starts to wander back towards my nose.

PS my opticians seem very deferential to hospital consultants.

PPS Should you have time to reply I would just be so grateful to hear another opinion other than a small local optician and a rather gung-ho consultant.

Thanks

I would say for your specs to go find a place with a real live Dispensing Optician...your type of prescription needs more knowledge than you will get from your average Optical Assistant or even Optometrist.

Splitting prisms is very common as it evens up lens weight and thickness and sounds like you have Zeiss lenses which are very spendy but generally excellent quality and optically really super for the more complex prescription. With higher prescriptions prism can be worked into the lens or created by placing a lens in a specific place in the frame, but those options differ with lens type. I am not sure of your exact prescription...you say you were -19 but I'd expect that to be substantially less post cataract so you may well have more lens options now than before.

My main concern would be that this botox is not going to be a longterm solution, (disclaimer...I know no specifics, but from what you have said here) so in your position I would phone around local opticians and find out who has an experienced dispensing optician and discuss options for your glasses with your current prescription and then interrogate the consultant as to how successful they envisage this procedure to be for you as it's not really a question of replacing your specs willy nilly

I am pretty sure I have seen orthoptists and ophthalmologists posting here before...so hopefully someone with more detailed knowledge for you and the procedure might see this and be able to advise!

I guess the problem with Botox is it’s not permanent so will wear off gradually, causing the amount of prism you need.

Are you sure it isn’t a precursor to surgery?

As an optometrist, my suggestion would be to have specs made up with no prism or whatever residual prism you need after Botox, then if you experience double vision as the Botox wears off a stick on fresnel prism could be used (not the most attractive option I’m afraid) until further Botox or surgery.

@LaurieSchafferIsAllBitterNow @SconeOfStone

Sorry as I'm not sure of the correct terms so may have got explanations a bit wrong.

Excluding squint my prescription is quite low. So -.25 and reading + 2.25 as my short sight of -19 was correct with catarract lenses.

But in non medical terms this short sightness has stratched? made thin? the back of the eye so they dont recommend surgery.

Botox was put forward as being something I could try as I was having so much difficulty with getting prisms and my optician didn't realise I would need less prism in the reading area.

But in fact I did get a pair of glasses made up without prism and (with alot of difficulty as individuals do not normal buy them) got some fresnek prisms as my very expensive german lens are useless for reading etc as the prism is too strong.

I am torn between postponing the botox (long journey during lockdown and not sure about acess to opticians also) and saving up money to go to specialist opticians who recommended tri-vocals where effectively they would make up 3 set of lens with different prism strength and then 1/3 of each lens is used ie I would pay for 2/3 of each lens to be thrown away!

Or giving the botox a go, and as I sometimes have to resort to wearing an eye patch when my eyes get tired, just go out in an eye patch. I might buy a pirate hat to go with it!

Over the years of having contact with different parts of the medical profession I dont think any of them apart from eye care have been so totally unconcerned about how a patient actually copes aftwards! ie if you have an operation you will be offer aftercare, perhaps a wheel chair or crutches. They eye "specialists" dont even know about the limit on prisms.

Thanks to you both.

I really appreciate your time and expertise.

Sorry I've spelt trifocals wrong.
www.allaboutvision.com/lenses/multifocal.htm

Sounds like Franklin split trifocals - which won’t be the most attractive either. I’ve done the occasional Franklin split bifocal but it’s difficult to find places to make them.

Could you manage with separate pairs of dist and near specs?

There’s no doubt your situation is complex and you need a good dispensing optician who can “think outside the box” to come up with a solution for you.

If you want to let me know what area you are in I may be able to suggest someone?

I have a squint, and although I've had varifocals for a few years now as my vision needs it (can't bloomin see at any distance now), before that I had reading and distance glasses purely for my prisms as it is much harder to hold single vision at short distances. Now I might consider 3 pairs for reading, PC and distance so they can be really tailored.

I've had therapeutic botox in my arm for dystonia, and though it was like flicking a switch on day 5 after the injections, it then slowly wore off, and I can't imagine having to deal with that in my eye muscles. Its also pretty imprecise, and if you can control your squint to an extent, you might find it goes the other way.

HI CMOTDibbler - sounds like our eye conditions are very similar. And as I have found out to my cost, I should never have been told varifocals with my strenght of prism would work.

So on a purely practical level, as someone who lives on their own, I cant see how I can manage a week letting the botox settle, booking an eye test for new glasses, getting them made. What would that be 2 to 3 or even 4 weeks not safe to get around. Or do the volunteer work I do!

And then, if the muscles dont hold, will they give me a set of fresnels and over a 3 month period keeping changing to stronger and stronger prisms.

It is so odd there is no literature at all on managing eye conditions post botox!

And also SconeOfStone - thanks for the offer. I am in the middle of composing an email to the Consultant and will decide when (and if) they reply. So may well be in touch.

I should add that I am also nervous because of lockdown and have so far avoided crowded places and public transport since March as medication I am on for something totally different apparently lowers my immune system.

This has made me think even harder than I might have done in non Covid times.

Have come back to just do a follow up as I know it can be quite disappointing not to know what happens after a thread like this.

Well after 3 versions I got my email ready to send, and just at the moment got a text to say treatment was cancelled because of lockdown but that I would get a telephone consultation.

So one of the consutant's juniors rang me. We had a nice chat but I realise I should have sent the email any way because hard as i tried I could make her understan. But as she talking about some who have been treated having to go out covering one eye, and that I might have to go back every three months, this didn't seem a practical solution!

So have put it all on hold while I try and work out with a properly qualified optician a better glasses (plural) solution. And they will do a phone contact in six months.

If my squint goes on getting worse I might then opt for the botox.

I think for the consultant because it is their skill they just go, this it what you should do.

But still find it really strange this gap between a specialist clinic not being able to offer some guidelines on best options for specific conditions.

Thanks for everyone who helped me by making me think about it more clearly.