Sensorimotor Considerations for Strabismus Surgery
Namita Kashyap, CO
PRE- AND POSTOPERATIVE SENSORIMOTOR MANAGEMENT
Ocular misalignment, diplopia, and/or visual confusion can occur for many reasons pre- and postoperatively and need to be addressed accordingly. The management of sensorimotor misalignment depends on the degree of symptoms and the extent of the ocular deviation. Diplopia following eye muscle surgery usually resolves without intervention within 1-6 weeks, and no treatment is required. However, if it persists beyond 4-6 weeks, or is particularly troubling to the patient treatment is typically recommended.
Optical Manipulation—Pediatric
For overcorrection or undercorrection of deviation after strabismus surgery, lenses can be prescribed to manipulate the angle of deviation (Table 56.1).
TABLE 56.1. Optical manipulations for postsurgical strabismus in pediatric patients | ||||||||||||||||||||||||
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Optical Manipulation—Adult
Monovision can be attempted for older adults with diplopia. This can be particularly helpful in cases of strabismus where there is inability to fuse centrally or peripherally (eg, epiretinal membrane (ERM), retinal detachment (RD), or macular hole causing central vision disruption).
Trial lenses in clinic are useful to decide which eye is best for distance/near and to determine which lens will blur enough to eliminate diplopia.
Prism can be combined with monovision to produce the best results.
Fresnel Prisms
Postoperative over- or undercorrections—Fresnel press-on prisms (Fresnel Prism & Lens Co., Bloomington, MN) are useful in instances of over- or undercorrection to eliminate diplopia and encourage binocularity. These temporary “stick-ons” are preferable to ground in prism, especially postoperatively, due to the ease of changing prism amounts as needed during the healing process.
Apply Fresnel prism to the inside of the glasses/sunglasses (Fig. 56.1). Plano lenses can be used if prescription glasses are not available and/or needed. The lines on the press on-prism will be oriented 90 degrees away from the base (ie, vertical lines for horizontal prism and vice versa).
Aim to wean down the power of prism slowly. Initially, try the least amount of prism that will eliminate diplopia and provide comfort. Allow time for development of fusional amplitudes.
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