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Strabismus Surgery Success Rates for Exotropia, Esotropia, Amblyopia and More!
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Dec 12, 2022
I poured over studies about strabismus surgery for hours and hours and these are the results that I found! I forget to mention amblyopia in the video, but it definitely has an effect on the surgery along with so many other factors. You can read about that and all the other specifics on my website at https://strabismussolutions.com/success/ Good Luck!
View Video Transcript
0:01
Strabismus surgery is done by an ophthalmologist, which is basically a doctor who specialized in the eyes
0:08
Now in the surgery, they're going to adjust the muscles of your eyes to try to make them look straight
0:13
That's the basic idea of surgery. Now when they talk about success, when you're looking through different research and studies
0:22
success is measured by what your result is. usually it's measured six weeks after the surgery. Sometimes they'll look at like more
0:31
long-term results, but they're looking at the six week mark and a success is if the eye turn is 10
0:38
degrees or less. So as I'm looking in the camera right now, you can see my eyes and they might look
0:42
straight, but this eye actually goes in about eight diopters. So this would be considered a success
0:49
even though my eyes aren't perfectly straight. So a success isn't necessarily measuring whether
0:54
the eyes are working together. Sometimes they do and that's part of it, but a success is really
1:01
looking at how they are aligned cosmetically. I've spent the last week reading every research
1:08
article I could about strabismus surgery and all the ins and outs and different, you know
1:15
if you have exotropia, esotropia, when double vision happens, if you get stereopsis, all these
1:21
different factors that go into strabismus surgery. And I'm going to share that with you now. You can
1:26
also see it on my website, strabismusolutions.com slash success if you want to see it more visually
1:33
But I'm going to go through that right now. You can tell I'm a little excited. That's because
1:37
I'm a math teacher by trade and numbers are just fun. So let's put on our glasses and let's get
1:45
started. Okay, so overall, if you take all of the people who get strabismus surgery, 70% of them get
1:55
better with one surgery. That means they get pretty good eye alignment in one surgery. The other 30
2:01
usually go on to have a second surgery. Now, of those people, 70% have a success with a second
2:09
surgery and 30% move on to have a third. And it just keeps going and going. So if you took a hundred
2:16
people and gave them all strabismus surgery, 70 would have a success with one surgery. 21 would
2:23
have success with the second one. Six would have success by the third surgery. And then you've got
2:29
three left and who knows what's going to happen, right? It just could go on forever. But if you
2:35
actually isolate different categories of people with strabismus, like people with esotropia or
2:41
exotropia or adults or babies or children, there's actually only one group that sits at 70%
2:48
Most of them are much higher or much lower on success rates. So the 1% that
2:54
actually has that 70% group is actually the highest percentage of overall people with
3:01
strabismus anyway, but it's people with exotropia. And so that's when your eye is turning out and
3:06
so they're, and they have a constant exotropia. So if your eye is constantly sitting out or your
3:12
child's eye is constantly sitting out, that has about a 70% success rate of getting better
3:19
Now, if you look at esotropia, that's where the eyes point in. If you look at a baby with
3:25
esotropia and it called congenital or infantile esotropia those success rates are way lower Only 50 of those ones get better with one surgery And if they have a high angle like I did as a baby it is going to be more like
3:42
you know, it's even lower. So I had an eye turn of 55 degrees, which is, or sorry, diopters
3:47
which is huge. My eyes were pointing really far in. I had three surgeries as a baby before I got
3:53
my eyes within that 10 diopters. That looked pretty good. But other cases that don't have as
4:00
much of a turn, you know, they might get better. And, you know, it just depends on the type. So
4:06
yeah, infantile esotropia, definitely lower success rate, usually is going to require multiple
4:12
surgeries. Now, if you're an adult with esotropia, again, the bigger the angle, the less success
4:20
you're probably going to have with one surgery because it's like a guessing game. You're trying to play with these tiny little movements that move the eye a lot. And so the larger the angle
4:30
of strabismus, the more likely it is that you're going to need a second surgery. If you have
4:34
intermittent exotropia, which means that sometimes your eye is out and sometimes your eyes are
4:40
straight and working together, you actually have a really, really high success rate. You're looking
4:45
at like 85 to 90% success rate, which is huge. There was even one study of children that showed
4:53
a hundred percent of those kids that had intermittent exotropia were able to get good
4:59
alignment and good fusion, which means both eyes were working together. Now of the kids that were
5:05
in that study, there was a small percentage that did have a second surgery, but still that's really
5:10
good results. So when you're comparing esotropia, you know, with a baby to intermittent exotropia
5:17
with a little bit of an older child, way better success with exotropia. Now adults, it's actually
5:23
swapped. So if you're an adult with esotropia, you're looking at like 80 to 90% success rates
5:30
for making your eyes within that 10 diopters. But if you have exotropia, it's just a little bit more
5:35
likely to wander. So they might get it straight right off the bat, but then it's going to wander
5:41
some after the surgery. And so that's a lot of times with exotropia in adults, they'll overcorrect
5:46
which is what they did with me because they didn't want it to just wander right back out to where it was
5:50
because that's a lot of times what will happen. And so success rate for adults with exotropia is about 73%
5:58
And that's coming from one or two studies. You know, I'm kind of putting information together from multiple studies
6:05
trying to pick the ones that look like they were done with, you know, good science
6:09
but I wasn't there running the studies. But this is what they say
6:14
Now, there was one study of over 400 people that got strabismus surgery that gives us a tiny little
6:22
hint into a way that we can improve those numbers. And that is torture. I mean, adjustable sutures
6:35
Adjustable sutures are maybe the worst ever. You can watch my video all about it. I'm a big baby
6:41
and I hated it. But what it is, is they do the surgery while you're completely out
6:46
and then they leave some of the stitches adjustable so that you can come in from, you know
6:51
one day later up to a week later and they can adjust your eye position
6:56
to get it just right. There's a lot of science that says
6:59
the alignment that you have at week one is the biggest predictor of success long And so if they can get that alignment really good within the first week it way more likely to stay
7:12
And so adjustable sutures, while horrible, because they're doing that while you're awake
7:17
they're like adjusting it in your eyeball. It really is just awful. But it improves the stats so much
7:24
So of these 400 people, there was the group that had adjustable sutures and the group that didn't
7:31
have adjustable sutures. The ones that did have the sutures, only 8% needed a second surgery
7:39
That means 92% got good alignment with the first surgery. And then the people who didn't have
7:45
adjustable sutures were more like 27, 28%, which kind of falls in line with that average of
7:51
you know, 70% success rate and then, you know, about 30% need a second surgery. So that's that
7:57
typical number, but the adjustable sutures group had a way better success. So while it is the worst
8:03
form of torture ever, definitely worth it. I'm super grateful that I had mine. Now I know you're
8:08
all wondering the same thing. Will surgery give me double vision? A lot of people will hear this
8:15
whether it's on like a Facebook page, you'll hear it from a vision therapy office. There's a lot of
8:20
fear out there. If you have surgery, you'll end up with unlimited double vision for the rest of
8:25
your life and it'll be horrible. There was another study done with hundreds of adults who got
8:32
strabismus surgery. And before surgery, they tested all of these adults by putting prism
8:37
glasses with prism on these people to see if they got double vision. Now, quite a few did get double
8:43
vision with the prisms in their glasses. Not all of them, but there were quite a few. And
8:50
after surgery, they tested everybody to see if they had double vision. Now, 9% did have double
8:57
vision right after surgery, that day after they experienced double vision. But at the six-week
9:03
follow-up appointment, only 0.8% had double vision still. So I think it was over 400 people. So that
9:12
meant three people had double vision out of several hundred. And all three of those people
9:19
had some double vision before surgery even started. So that means like almost everybody
9:25
like 99.2% do not get double vision after surgery. If you had double vision before
9:33
yeah, there's a chance you're still going to have it after. There's also a chance that surgery can
9:37
help fix it. But if you didn't have double vision before, you're not going to have it after. You
9:43
might have it for a short time, like for a few weeks. This did happen to me and it was awful
9:48
I'm not going to say it was a pleasant experience, but it wasn't horrible and it was okay. It went
9:54
away. My brain adjusted and it was totally fine. Your brain knows how to figure this out. It's
9:59
been working on it forever. So don't let double vision be the reason that you stress out about
10:05
this. Now I will see that I don't think cosmetic alignment is the only thing we should be going for
10:14
I personally want both of my eyes to be working together. I don't want them to just look straight
10:20
I want them to like work and see depth. That's what I was going for. And there is some
10:28
research done about whether or not people are able to get stereopsis That stereopsis is when both eyes are working together they pointing at the same place and they able to create depth with what they seeing So if you have never had stereopsis before you are not going to get it because of surgery
10:50
almost ever. If you're an adult, like it's just like never going to happen
10:55
My surgeon has been doing surgery for like 15 years. He said it's happened twice
10:59
And he does, you know, multiple, you know, probably like 20 a week. I don't know. I don't know how many surgeries he's done. Thousands probably. It's happened twice
11:06
Just the spontaneous like miracle of getting your eyes lined up and working. Now, if you're a little
11:14
tiny kid or you have a child who's, you know, maybe like six months old or, you know, really
11:18
little and their brain is still learning how to develop that stereopsis, it's in that learning
11:22
stage. Then in 25% of cases, they are able to gain stereopsis and fusion through the surgery. So
11:31
really small percentage. It's not likely I wouldn't count on it. Now there's this other
11:35
group of people where their eye is intermittent or adults who have got like some thyroid disease
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or diabetes, or there's all sorts of crazy stuff that can happen as an adult that leads to
11:46
strabismus, different like nerve things, all this. If you've had stereopsis your whole life
11:53
and then something terrible happened and you, your eye turned and you have double vision or
11:59
or you've lost your ability to see depth, you know, your 3D, 96% of people that have surgery
12:08
are able to regain stereopsis. So super high, especially I think it was that high if it
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if they lost it within the last year. The longer you've been without the ability to use both eyes
12:19
the less likely that it is that surgery is going to help you get that on its own
12:23
these numbers aren't great like you're like uh so pretty much nobody is going to get stereo
12:31
yeah pretty much unless you have an intermittent eye turn and you use both eyes some of the time
12:35
surgery is probably not going to restore stereopsis but that's okay because that's
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why we have vision therapy vision therapy is what teaches your eyes to work together
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once the eyes are in a better position and sometimes you don't even need this surgery
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Sometimes, especially with an intermittent eye turn, you're not even going to need surgery
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Vision therapy alone can fix that, or if it's a really small angle
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But vision therapy is basically physical therapy for your eyes, and it's even for your brain
13:04
It's just teaching your brain to use what both eyes are seeing. I went on for about 45 minutes talking about how awesome vision therapy is
13:11
but I decided to cut it out so I could not bore you to death. If you want to read all about it, though, head over to my website
13:18
strabismusolutions.com slash success. And you can learn all about how surgery and vision therapy
13:24
can work together. And I also have a great article with all of these detailed statistics
13:29
that you can read and learn more about your specific case. Now, if that's not enough
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and you want to talk with me about your case and have me go through all of your history and help
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you understand what your condition is better and what your, you know, success rates would look like
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whether it's vision therapy or strabismus surgery, I'd love to do that. You can schedule a consult
13:50
with me on my website as well. Just go to strabismusolutions.com and click the work with
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me link and it's in the front. So I hope you are able to reach your ultimate vision and I am here
14:03
to help you on your way. Be sure to subscribe to my channel and check out these other videos that I
14:09
have. Have a good one
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