Dr. Dan B. : Hello and thanks for your question. Are you available to chat?
yes, thanks for the quick response
Dr. Dan B. : Let me address these questions. Number one, it is possible to have a change from 2 to 4 diopters in six months. Changes in the refractive error usually follow growth cycles and children at this age are growing rapidly. So this is not surprising. Number two...
Dr. Dan B. : The surgery is very unlikely to have caused the increase in farsightedness. It is possible that after the surgery, there was more binocular fixation, and the increase in successful focusing may have spurred the farsightedness along, but if it wasn't in his genes to get that farsightedness, he wouldn't have gotten it. Customer:
yes, i suspected that number one was more likely, but wanted to be sure. thanks
Dr. Dan B. : Yes, glasses can be prescribed for hyperopia of 2 dpt, but, depending on the case, many times after the doctor just will not prescribe that low level, because it usually does not improve the esotropia if there's only 2 dpt. Some ophthalmologist will prescribe the glasses just in case, but many will not.
Dr. Dan B. : Number four, For the most part, no, I don't see any significant ramifications of having surgery first and then having glasses. The important thing is the glasses are helping now as long as his eyes are straight in the glasses this is the best hoped-for outcome.
that is very helpful, I'm just a little curious why, since it's not surprising for the diopters to change from 2 to 4
why is wasn't suggested to wait a little while
I understand in the end, the parent are responsible for the decision
but your answers have been very helpful and reassuring
Dr. Dan B. : Number five, no, I do not think the chances for surgery are higher because he had surgery for esotropia prior to glasses, I think this is all dependent on how his eyes are going to grow, what his refractive error is going to be, and how his esotropia responds to the glasses. I would not be surprised if you need another surgery, but since the esotropia is controlled by the glasses now, I would not be surprised if he didn't require another surgery.
Dr. Dan B. : He likely was not recommended to wait, because no one can predict the refractive error and how it will change, but the longer he goes without binocular fixation, the more likely the amblyopia is to continue or worsen, and the less likely he is to develop a binocular fixation and have a good outcome. Does this make sense?
yes, it does, thanks
but can one still have binocular improvement after a surgery and not have the esotropia resolved?
i assumed that one outcome is related to the other..
Dr. Dan B. : Oh yes, you can especially if his eyes are straight while wearing the glasses. Even if the esotropia is still present, as long as the eyes are straight while he's wearing the glasses and the glasses are worn all day long, yes it can definitely improve.
but the surgery by itself probably did not improve binocularity if the esotropia was still present
after the under-correction, and before the glasses
Dr. Dan B. : The eyes being straight and focused on the same object at the same time is what dictates the ability to have binocular fixation. No matter how this is achieved, either with the surgery alone, glasses alone, or surgery glasses. What matters is whether the eyes are straight the large majority of the time.
Dr. Dan B. : That is likely correct, I just can't say for sure, not having examined him.
and they are now, so I guess that is what I should be focusing on.
Dr. Dan B. : Absolutely--that's the desired goal so that's a very good thing.
Dr. Dan B. : My pleasure. Do you have any other questions about this?
no, no more questions
you have been very helpful
Dr. Dan B. : Okay. Good luck. My pleasure. Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied. My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry!
Dr. Dan B. : Happy to help.