Strabismus Update

Before our trip to Disney World Alyce had her annual eye checkup. As mentioned earlier Alyce was diagnosed with Strabismus at an early age and had surgeries to correct it. Now every year we take her in for a checkup. I'm not worried about her eyes no longer aligning but the checkup also consists of a vision test so we know that Alyce's vision is tested annually by an expert in the field.

This year's visit wasn't without some excitement. Turning onto the road leading to Children's Hospital our car with Mom and Alyce in it was hit broadside by a driver that had run a red light. To see it in text makes it seem worse that it really was. Both Mom and Alyce had no injuries and 2 weeks without our car and $6,000 later (paid by his insurance) we were made whole again.

The worst part about these appointments is that you are always waiting. Waiting for the initial test. Waiting to get eyes dilated. Waiting for the dilation solution to work. Waiting to see the head doctor. It's all very frustrating. The whole thing took the better part of 3 hours and we were probably face to face with a care provider a grand total of 15 minutes.

Pushing all of that to the side Alyce's eyes are doing great. Her vision (focus) is fine and in the doctor's words "Alyce is the text book example of a successful eye muscle surgery". We were really pleased to hear that.

Alyce will always have a few hitches when it comes to her vision though. If she puts her head to one side or the other her eyes can go misaligned and it looks kind of weird. The doctors told us in the past there isn't anything they can do to correct that without affecting her normal heads up vision. You take what you can get I guess.

Strabismus Update

Last week Alyce had her followup eye doctor appointment. At this point Alyce is almost one year past her last surgery. From the earlier followup appointments we knew that Alyce's eyes were lining up and this appointment was just to make sure she was continuing to stay that way.

After a two and a half hour appointment we are happy to announce her eyes are still aligning. The doctors dilated her eyes and checked her focus. It turns out that she has a little bit of nearsightedness. Supposedly it isn't severe enough to need glasses, but I guess it is something we should get checked out before she heads off to school in three years.

We have another follow up appointment a year from now, but we really don't have anything to worry about. Even though sometimes we did have to wait a while for a doctor Mom and I only have good things to say about the pediatric opthamologist at St. Louis Children's Hospital.

Strabismus Part 2

The goal of Alyce having Strabismus surgery is more than cosmetic. It is important that she have binocular vision before age 2. Binocular vision means that when you look at something each eye gets a different picture and your brain stitches them together for a single picture. Vision that is not binocular would generate double images of two different things. The reason why it needs to be fixed before age two is that at an early age the brain is malleable. If we left her eyes unaligned eventually her brain would choose one eye as the dominant while ignoring the input of the other. Over time she would eventually become blind in the weaker eye.

The above statement is important because after Alyce's surgery she did achieve binocular vision, however it wasn't perfect. For the first week or so her eyes aligned perfectly, but after that her right eye started to drop. She compensated for the drop in the right eye by tilting her head to the right. Depending on what she looked at it could be up to 45 degrees. While this made for some really great pictures it wasn't something we wanted to leave hanging out there. So after a few more doctor visits it was determined that Alyce needed a second surgery. We would have to wait 6 months for her next surgery so we could allow her eyes time to heal from the first. This time however we would have to patch her good eye for the entire six months rather than just a month before her first surgery.

Patching an eye means that we had to cover her good eye so that she had to use her bad eye. Forcing her to use her bad eye stopped her brain from forgetting about the good eye. We covered her good eye by using really big band-aids designed for that purpose. Alyce was surprisingly agreeable to the whole process. She didn't complain much and didn't have the manual dexterity to peel off the cover.

The second surgery came after her first birthday. This time Alyce did not need an MRI so she only had to be put under once. The surgery was completed with no complications and again both eyes needed to be adjusted. The recovery was a little rougher than the last time in that she woke up in a cranky mood or at least she complained about it more. We think she was just hungry seeing how she hadn't eaten since before she went to bed the previous night. The nurses gave her some vanilla wafers (her first cookie ever) and that seemed to improve her mood. Another side effect of the surgery that we had both times was Alyce cried red bloody tears. Luckily the bleeding stopped rather quickly but it was still hard on mom and me.

Six months after the second surgery Alyce was given a clean bill of health. Her eyes had healed well, they were aligned, and she wasn't tilting her head. We have a followup appointment in September that should be her last provided no additional treatment is needed. Mom and I are very grateful for the care provided by the St. Louis Children's Hospital and can't thank them enough.

Strabismus

One aspect of Alyce's life that we haven't discussed is her strabismus. Strabismus is a condition normally called cross-eyed where a person cannot align both eyes under normal conditions. There are different types of strabismus and in all cases it does require some treatment. Alyce's case was first diagnosed at her 3 month checkup by our pediatrician. At that point we were sent to a specialist in pediatric opthamology at St. Louis Children's Hospital.

Alyce's case was different than most in that her eyes deviated vertically rather than horizontally. Her eyes didn't cross, but pointed differently up and down. The doctor seemed interested by this and wanted to take some pictures of Alyce for his records. A childhood model at three months! He wanted us to come back in month to see if the situation progressed or regressed and at that point would determine if surgery was needed.

It turned out that surgery was needed and was scheduled for the middle part of April 2007. Leading up to the surgery Alyce needed to have an MRI of her eye muscles. It is impossible to get a 6 month old to sit still in a loud MRI machine so she had to be put under sedation for the procedure. The worst part of that experience was that the only vein they could find for an IV was in her forehead; up to that point they had stuck her unsuccessfully in both arms. It is hard being a parent seeing your child in pain and not being able to do anything about it. I have to give the nurses credit they did all they could to minimize Alyce's discomfort.

Strabismus surgery requires repositioning of they eye muscles where they attach to the eye. By adjusting the connection point you can make a muscle either stronger or weaker in a specific direction. If memory serves each eye is controlled by six muscles two on top, two on bottom, and one on each side. In Alyces case they had to work on the muscles on both eyes. What surprised us about that was it seemed like Alyce had one "good" eye and one "bad" eye so why did both need to be worked on? The explanation we received was that both eyes had issues, but since she had a dominant eye it looked right even though it wasn't. The surgury went off without a hitch and after the longest hour and a half of our life our daughter was back in our arms.

The recovery post surgery looked much worse than it actually was. The whites of Alyce's were red, she was groggy, and her eyes felt scratchy. After a nap she seemed to bounce back to normal with no averse effects from the surgery.

In later posts I will explain the continuation of this story. I will give this hint, it does have a happy ending.