Post-Surgery Confusion: Vision Changes After Strabismus Surgery

Post-operative issues after strabismus surgery!

I have had esotropia since childhood, which has led to amblyopia in my deviated 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 approximately 1.0, while the other is around 0.2.
Consequently, I have become 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'm unsure about the difference between binocular and monocular vision.
Recently, I underwent strabismus surgery, which corrected the position of the deviated eye.
However, my vision remains the same.
Whether it's during the doctor's examination, when friends see me, or even when I take selfies, my eyes appear straighter than before, with less of an inward strabismus appearance.
The sclera on the inner side of my eyes is also more visible now, unlike before when it was barely noticeable.
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 sense 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 perceive my eyes as looking in different directions.
They all say no, that I am looking at them, and that my condition is much better than when I had strabismus.
I also took selfies, and while the photos show my eyes looking straight, upon closer inspection, there seems to be a slight misalignment.
However, when I show the same photos to others, they perceive no issue and see me looking at the same point.
Interestingly, I did not experience this confusion before the surgery, despite having inward strabismus.
I was aware that my eyes were looking at the front of the mirror, even if occasionally one would drift upwards.
Now, post-surgery, I have this sensation of my eyes looking in different directions, which makes me hesitant to look at my reflection—it's quite strange!
I have heard that this situation might arise because I have not established an assessment of my binocular vision system and lack training for my extraocular muscles.
Therefore, I may still be relying on monocular vision after the surgery, which could explain my current experience.
I'm not certain if this is the case, but it is one explanation I have encountered.
I have also heard that optometrists specialize in the assessment of the "binocular vision system" and "extraocular muscle training." However, when I searched online, it seems that optometry services in Taiwan primarily focus on contact lenses, leaving me unsure of what to do next.

Do you know why this issue is occurring? How should I address and improve it? Are there specific clinics or treatments you would recommend?
Duration: It has been almost two months since the surgery.
Additionally, it seems that those who have not undergone surgery do not experience this sensation.
Is this normal? Why did I not feel this way before the surgery, but now I do? (I am referring to looking in the mirror.)
I have also heard about a new technique called "E-visual neurotraining," which is said to help adults with amblyopia.
What are your thoughts on this new technique?
Thank you for your assistance!

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

Dr. Ke Meilan reply Ophthalmology

Hello! 1.
Usually, when you look with both eyes, you won't feel anything.
2.
Your issue mainly stems from the retina's focus being off the central point, which is why others perceive you as having normal alignment.
However, your optimal point is actually strabismic, so don't train it too much.
I'm concerned that your poor vision in one eye may interfere with your normal vision, potentially leading to a decline in your overall eyesight.
3.
I've heard that improvements are possible, but complete recovery has not been achieved, and the costs are high.

Reply Date: 2007/09/30

More Info

After undergoing strabismus surgery, it is not uncommon to experience confusion regarding visual perception, especially for individuals who have had a long history of strabismus and amblyopia (lazy eye). Your situation is particularly complex due to the significant visual disparity between your two eyes, which can lead to a reliance on monocular vision (using one eye) rather than binocular vision (using both eyes together). This reliance can create challenges in adjusting to the changes that occur post-surgery.

Understanding Your Experience
1. Perception of Eye Alignment: Post-surgery, you may feel that your eyes are not aligned correctly, even if they appear straight to others. This sensation can stem from your brain's adaptation process as it learns to interpret the new positioning of your eyes. The brain has been accustomed to the previous misalignment, and it may take time for it to adjust to the new alignment. This is often referred to as "visual confusion" or "sensory conflict."
2. Monocular vs. Binocular Vision: Since you have relied heavily on one eye for vision, your brain may still be favoring that eye, leading to difficulties in integrating the visual input from both eyes. This can result in feelings of disorientation when looking in the mirror or at objects, as your brain struggles to reconcile the different visual inputs.

3. Visual System Training: The lack of a developed binocular vision system can contribute to your current feelings of confusion. Engaging in vision therapy or exercises designed to improve binocular coordination may be beneficial. These exercises can help retrain your brain to process visual information from both eyes more effectively.

Recommendations for Improvement
1. Consultation with a Vision Specialist: It is crucial to consult with an optometrist or ophthalmologist who specializes in binocular vision and strabismus. They can assess your visual system and recommend appropriate therapies or exercises to help improve your binocular vision. Look for professionals who have experience with strabismus and amblyopia rehabilitation.

2. Vision Therapy: Vision therapy, which may include exercises to strengthen eye coordination and improve visual processing, could be beneficial. This therapy often involves activities that encourage the use of both eyes together, helping to reduce the confusion you are experiencing.

3. E-Visual Neurotraining: The technique you mentioned, "E-Visual Neurotraining," is a newer approach that utilizes technology to assist in visual rehabilitation. While research is still ongoing regarding its effectiveness, it may provide a novel way to engage your visual system and promote better integration of visual inputs. Discuss this option with your eye care provider to see if it is suitable for your situation.

4. Patience and Time: It is essential to give yourself time to adjust to the changes following surgery. The brain's adaptation process can take weeks to months, and it is not uncommon for patients to experience fluctuations in their visual perception during this time.

5. Regular Follow-ups: Ensure that you have regular follow-up appointments with your eye care provider to monitor your progress and address any ongoing concerns. They can provide reassurance and guidance as you navigate this adjustment period.

Conclusion
Your experience post-strabismus surgery is a common one, particularly for individuals with a history of significant visual disparity. The feelings of confusion and misalignment perception are likely due to the brain's adjustment to the new eye positioning and the need to develop a functional binocular vision system. Engaging with a vision specialist, considering vision therapy, and being patient with the adjustment process are crucial steps toward improving your visual experience. Remember, you are not alone in this journey, and there are resources available to help you regain a comfortable and functional vision.

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