Post-Strabismus Surgery: Vision Changes and Solutions

Q: Post-Strabismus Surgery: Vision Changes and Solutions

Hello, Miss： Based on your description, the postoperative eye alignment results appear to be normal according to your friends' observations. <br>However, you still feel something is off. <br>Possible reasons for this situation include： <br>1. <br>Poor stereopsis： The development

Questions about strabismus surgery!

I have had esotropia since childhood, which has led to amblyopia in my affected eye.
This means that the eye with strabismus also has reduced vision, resulting in a significant disparity between my two eyes.
After wearing glasses, one eye has a vision of about 1.0, while the other is only 0.2.
Consequently, I have been accustomed to monocular vision for a long time, primarily relying on one eye to see things.
The other eye may also be looking, but I don't know how to engage or use it, so I am unsure about the difference between binocular and monocular vision.
Recently, I underwent strabismus surgery, and the position of the affected eye has been corrected.
However, my vision remains the same.
Regardless of whether it is the doctor examining me, friends observing me, or even when I take selfies, my eye appears straighter than before, with less of an inward squint, and there is more visible sclera on the inner side of the eye compared to before.

However, a new issue has arisen.
Everyone says my eyes look more aligned, but since the surgery, when I look in the mirror, I feel like the operated eye is looking to the side rather than straight ahead.
When I bring the mirror very close, that eye seems to look even more to the side, giving me a sensation of exodeviation.
As a result, every time I look in the mirror, I feel like my two eyes are looking in different directions, which is quite confusing!
I have asked friends I converse with if they think my eyes are looking in different directions, and they all say no; they see me looking at them, and my condition is much better than when I had strabismus before! I have also taken selfies, and the results show that my eyes appear aligned.
When I zoom in, there seems to be a slight difference in where they are looking, but when I show the same photo to others, they perceive no issue and see me looking at the same spot!
However, this confusion in the mirror did not occur when I had esotropia.
Despite the inward squint, I always knew both of my eyes were looking at the front of the mirror, with only occasional involuntary upward drifting.
But now, post-surgery, I experience this sensation of looking in different directions, which makes me hesitant to look at myself in the mirror—it's quite strange!
I have heard that this situation might be due to my lack of assessment for establishing a binocular vision system and the absence of evaluation for extraocular muscle training.
Therefore, I may still be relying on monocular vision post-surgery, which could explain this.
I am not certain, but this is one explanation I have encountered! I have also heard that optometrists are quite specialized in assessing the "binocular vision system" and "extraocular muscle training," but it seems that the optometry services in Taiwan primarily focus on contact lenses, so I am unsure what to do.
Do you know why this issue is occurring? How should I address and improve it? Are there any clinics or treatments you would recommend?
Duration: It has been almost two months since the surgery.
Additionally, it seems that others who have not undergone surgery also experience similar feelings as I do...
Is this normal? Why did I not have this sensation before the surgery? Why does it occur after the surgery? (I am referring to looking in the mirror.)
By the way, I have heard about a new training called "E-visual neurotraining," which is said to help adults with amblyopia.
I wonder what the physician's opinion is on this technique.
I would greatly appreciate your assistance, Dr.
Liu.
Thank you!

Dai Mei, 20~29 year old female. Ask Date: 2007/09/30

Dr. Liu Jingxian reply Ophthalmology

Hello, Miss: Based on your description, the postoperative eye alignment results appear to be normal according to your friends' observations.
However, you still feel something is off.
Possible reasons for this situation include:
1.
Poor stereopsis: The development of stereopsis matures from birth until around two to three years of age.
If strabismus occurs at a young age, it can affect this development.
Typically, even after successful correction of strabismus in later years, the recovery of stereopsis is generally not optimal.
2.
Excessive binocular disparity: This refers to the difference in refractive error between the two eyes.
Often, the amblyopic eye may develop a tendency toward high myopia, and if the binocular disparity exceeds 200 degrees, it can cause differences in the perceived image size between the two eyes, leading to visual disturbances.
3.
Presence of residual small-angle strabismus: Even a slight degree of strabismus can cause visual interference.
I recommend that you consult with a strabismus specialist for further evaluation.
As for "E-visual neurotraining," it involves various visual training exercises aimed at improving visual acuity.
The effectiveness of this approach is not absolute; some individuals may experience significant visual improvement, while others may see limited progress.
It would be beneficial to learn more about it.
Wishing you good health,
Dr.
Liu Jing-Hsi,
Ophthalmology, Taipei City Hospital, Zhongxing Branch, Taiwan.

Reply Date: 2007/09/30

More Info

Post-strabismus surgery, particularly for individuals who have lived with conditions like esotropia (crossed eyes) and amblyopia (lazy eye), can lead to a variety of visual changes and challenges. Your experience is not uncommon, and it is important to understand the underlying reasons for these changes and how to address them effectively.

Understanding Your Experience
1. Visual Perception Post-Surgery: After strabismus surgery, many patients report a feeling of misalignment or that their eyes are not looking in the same direction, even when they appear straight to others. This can be attributed to several factors:
- Neural Adaptation: Your brain has been accustomed to processing visual input from one eye (the dominant eye) for a long time. Post-surgery, your brain may still be adjusting to the new alignment of the eyes, leading to confusion in visual perception.

- Depth Perception: The brain relies on both eyes working together to create a single, three-dimensional image. If one eye has been dominant for a long time, the brain may struggle to integrate the input from both eyes, leading to a sensation that they are not aligned.

- Amblyopia: If one eye has significantly poorer vision (as in your case), the brain may still favor the stronger eye, making it difficult to utilize both eyes effectively.

2. Mirror Image Confusion: The feeling that your eyes are looking in different directions when you look in the mirror could be due to the new alignment not yet being fully integrated into your visual perception. This is a common experience after surgery, especially for those who have had a long history of strabismus.

Recommendations for Improvement
1. Vision Therapy: Engaging in vision therapy can be beneficial. This type of therapy often includes exercises designed to improve coordination between the eyes and enhance binocular vision. A trained optometrist or vision therapist can guide you through exercises that promote the use of both eyes together, helping to retrain your brain to process visual information more effectively.

2. E-Visual Neurotraining: The technique you mentioned, "E-Visual Neurotraining," is a modern approach that has shown promise in treating amblyopia and improving visual processing in adults. This method often incorporates digital tools and exercises that can help strengthen the neural pathways associated with visual perception. It is worth discussing this option with your eye care provider to see if it is suitable for your situation.

3. Regular Follow-ups: Continue to have regular follow-ups with your ophthalmologist or optometrist. They can monitor your progress and make adjustments to your treatment plan as necessary. If you feel that your concerns are not being addressed, consider seeking a second opinion from a specialist in strabismus or binocular vision.

4. Patience and Adaptation: Understand that it may take time for your brain to adapt to the new visual input. Many patients experience fluctuations in their perception and visual comfort during the recovery phase. It is essential to be patient with yourself as you navigate these changes.

5. Support Groups: Connecting with others who have undergone similar surgeries can provide emotional support and practical advice. Online forums or local support groups can be valuable resources.

Conclusion
Your experience post-strabismus surgery is a complex interplay of physical changes and neural adaptation. While it may feel disorienting now, many individuals find that with time, therapy, and support, their visual perception improves significantly. Engaging with professionals who specialize in binocular vision and vision therapy will be crucial in your recovery journey. Remember, you are not alone in this experience, and there are effective strategies available to help you regain a more comfortable and functional visual experience.

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