Ophthalmology vs Vision Therapy

I am breaking my promise here not to write anymore. However this is for a good cause.  

There are so few blogs about adult Strabismus that I fear people are getting only one side of the story on surgery vs. vision therapy. I edited this post on May 1, 2011.  Sorry it is long, but my hope is that it's worth the time it takes you to read...

My purpose in writing this is to encourage people to be as in formed as possible when it comes to weighing the options of surgery vs. vision therapy.   If you choose to search the web lean towards the sites that are .org's or .govs.  These have more credulity. Reading personal experiences on blogs are nice but, including mine, they are PERSONAL experiences.  You will have your own.  Just make sure you are educated by people who really know the science behind this eye disorder.

I have only heard about VT this past year - after all my surgeries.(4 surgeries - 8 procedures and FIVE cortisone trochlear  injections) Frankly, I was afraid I took the easy way out in having some one else fix it and someone else pay for it. ( although my deductible is HUGE) It made me question whether I was just lazy and didn't want to do the hard work to "fix myself" with therapy.  Was it my fault? Was I just a weak person for choosing surgery? I just didn't want to work hard to fix my problem?  That's what led me to ask this orthoptist questions about VT.

One blog mentions the authors opinions that Ophthalmologists do surgery for cosmetic reasons.  That is one view point.  Just because it is on the internet does not now make it a fact. That would make an ophthalmologist a cosmetic surgeon.  Which they are not.  From my personal experience how I look is the least of my problems. Surgery for me was critical. I knew I was soon to loose all single vision.  I had an inferior oblique that was too long. (we only learned that IN surgery)   No amount of exercise could change that fact.  I had a head tilt all of my life.  With one 3 hour 'nap' (surgery) I wake up and my head tilt nearly gone.  My neck pain is gone.  That is NOT cosmetic.  I woke up with depth perception.  That is not a cosmetic result.  That's a functional result.  Least of all, I don't see double anymore.

Vision therapy (VT) verses Surgery is one hot topic apparently in the 'eye profession'.  Keep a clear head when talking to Dr.'s and therapists.  Does it feel like a sales pitch?  Does one profession completely put the others down?  Maybe you'll agree, when a person is truly in the right, there is no need for putting others down.  You should clearly understand YOUR eye problem first.  Questions to ask; "Do I have a muscle weakness, or do all my eye muscles work equally? I personally, had a 4th Cranial nerve that wasn't working correctly, so no amount of exercise could bring back the nerve to functioning correctly.  What is YOUR situation?  If you do not clearly understand what your problem is how can you understand how to treat it?  Really good Doctors let you ask any and all your dumb questions and they would never think you dumb for asking them.
According to one orthoptist there are two types of Strabismus.
1):  there is NO obvious muscle weakness; the eyes move normally in all directions, they just don't work together normally. Usually this type develops in early childhood and is NOT associated with double vision. Some unfortunate souls develop double and it can be tricky to treat.

2): There IS a muscle weakness (various causes, various types and combinations of muscle weakness) and the eyes do NOT move normally in all directions. When you have this type (as I did) the muscle imbalance needs to be addressed in order to get the eyes to work together normally again - this involves either i) repositioning the eye muscles themselves or, ii) moving the double image using prism glasses so that it can be "fused" by the brain with the 'real' image (not possible in ALL types of double).

Something I learned this past two weeks:

Where VT (vision therapy) comes in: VT mostly tries to re-train the brain in how it processes what is seen. Occasionally it will claim to strengthen the muscles themselves, but i think even the most outspoken VT proponents wouldn't claim to be able to re-charge a weak/underacting nerve!

Now, if you have normally moving eyes that are out of balance the whole idea of VT has slightly more credibility than if you have non-normally moving eyes. As far as I understand it, no amount of VT in the world will make a weak / paralyzed nerve / muscle suddenly start moving / acting normally again.

SO, in my case the eyes needed to be mechanically re-balanced so that the images from each eye would line up with each other and your brain could then stand a chance at fusing them into  one 3-d image. (Prisms can work to optically relocate the double image but this does NOT work if you see a twisted / tilted image (which I did have) ... surgery is the main treatment option in that case)

Questions to ask your doctor's and therapists;  Well, there are endless questions if you are me, just ask my poor eye doctors.  I never stop asking questions.  But if you are considering vision therapy or surgery, why not ask each professional, why do you feel your approach would be superior to this other approach?  For instance in talking to a surgeon: " why do you feel VT would not work in my case?"  In talking to a VTherapist maybe ask them; " Why do you feel surgery is not the answer?" Go home and think about it.  Does their explanation make sense to you?

It is a valid question why insurance would cover surgery and not vision therapy.  It should raise a red flag or at least a yellow one that says "Proceed with caution"  Do your own research and not on Wikipedia.  My last surgery was complicated and cost $21000. or so.  So I don't think they are taking the cheap way out.

Insurance companies must feel surgery is a more stable, predictable out come.  Also consider, will vision therapy UN- suppress some suppression you've been having? Great!  Maybe it can.  But what is the alternative?  Both eyes working but not necessarily together?  When that happens you have double vision.  I'll tell ya from experience.  Double vision isn't necessarily better than suppression.  Much more upsetting.  There are no guarantees that you will move past double vision into single vision, and how long might that take?  Make sure you are not trading one problem for another. Some times the solution can be worse than the problem. This is a huge concern that surgeons have with VT.

Depth perception is not someone with misaligned eyes enjoys.  Will you get that back?  I hope you do.  But I don't know if I would put all my chips on the table just for that.  Why do I say that?  Because I didn't have it for 36 yrs. and you know what?  I got along just fine.   I didn't feel like I was 'suffering'  because I wasn't.  Now I think I have it back but you know what after the first two months you forget you have it back.  (until you get in front of a 3-d movie -and it is really really fun-  but that's like 3 times a year- you can have a full life with out seeing all aspects of a movie)

Maybe this is cold and harsh reasoning.  But I am genuinely afraid of people not using BOTH eye doctors and therapists.  Why can't every one play together nicely?

My blog is simply to log my journey's ups and downs of this amazing experience. Writing is like therapy for me, so If you can learn something from my experience, great.  However, it is not my intent to teach something here.  I just want to encourage ones to do their own research from legitimate sources.  Stick to the .org's or .gov. websites you'll fare much better.  I wish for everyone to have the success I found.  I lost my hope for many years and now have it back. Best wishes to you!
Greta

3/31/13 found this. Might be worth a readhttp://quackwatch.org/01QuackeryRelatedTopics/eyequack.htmlhttp://quackwatch.org/01QuackeryRelatedTopics/eyequack.html