常见问题|Overview
Frequently asked questions with Dr. David Hunter
Q: What is strabismus and why does it occur in adults?
A：Strabismus occurs when eyes don't line up with each other. Usually, one eye seems to be wandering. You may have heard this referred to as "crossed eyes" or "wall eye."
有时这被称为“懒惰的眼睛”，但这确实是弱视，我们以后可以谈论。成年患者从小就可能患有这种疾病，但从未成功治疗，或者他或她以后可能患有疾病或受伤。天生患有斜视的人，如果没有对待，他们将失去双目视力，否则他们会产生双眼视力。
Q: What is binocular vision?
A：Each of your two eyes sees a slightly different picture of the world. If you have binocular vision, it means your brain can take the two pictures from the two eyes and put them together into a single three-dimensional perception of the world around you. This is a complex skill that is quickly lost when the eyes don't line up. Without binocular vision, your depth perception may be limited. Unlike other vision problems, this cannot be resolved with glasses.
问：斜视会引起双视力吗？
A：斜视始于童年时,大脑learns to ignore the image from one eye just to avoid double vision. On the other hand, when strabismus begins in adulthood, the brain cannot just ignore one eye. In those cases, double vision can emerge and it can become quite unbearable. Patients might try closing one eye, tilting the head, prisms, "pirate" patches, even covering one eyeglass lens with fingernail polish or tape just to try to get rid of the double image.
Q: You mentioned "amblyopia." What is that?
A：Amblyopia (or "lazy eye") is a problem with vision that develops in childhood. The brain decides to ignore a misaligned eye to avoid double vision. The brain never learns to see clearly out of that eye. Once amblyopia develops in childhood, it has to be treated right away or the vision will never recover. Amblyopia can't be treated in adults, but if the eyes are misaligned they can still be straightened even if amblyopia is present.
Q: Am I too old to have my strabismus treated?
A：As an adult with strabismus, you may have been told in the past that nothing can be done. This is simply not true. In most cases, eye muscle surgery is a successful, safe, and effective treatment for strabismus in adults of all ages. The good news is that it is never too late for surgery. I have personally operated on patients in their 90's, and they were delighted with the results.
In addition to correcting misaligned eyes, treatment can restore binocular vision and even expand the field of vision in some cases. I have many patients who have said after surgery, "Why didn't I take care of this years ago?" They realize how much it affects their self-confidence. Finally, they can look someone in the eye or they can get rid of those heavy prism glasses or patches that they've been struggling with.
问：当我还是个孩子的时候，我已经进行了手术，或者可能多次手术，医生说肌肉再也无法动弹了。
A：这并不一定意味着您的病情无法纠正。一些医生可能没有很多教育或治疗复杂的眼部肌肉状况的经验。在波士顿儿童医院，我们的医生每天使用专门的技术来治疗复杂的斜视，这些技术可以使可能无法在其他地方接受治疗的患者受益。当然，有些情况确实无法解决，但是了解您的案子的唯一方法是访问我们就您的特定眼睛状况进行咨询。
问：但是我是成年人。我为什么要去波士顿儿童接受治疗？
A：许多成人斜视纳闷,“为什么我们rld would I go to Boston Children's Hospital? I'm not a child anymore." The answer is that misaligned eyes are common in children but not so common in adults. Ophthalmologists who care for children tend to have the most expertise in treating eye muscle conditions. At Boston Children's Hospital, ophthalmologists are specially trained to perform the delicate eye muscle surgery required to align the eyes properly, in patients of all ages.
If you do require surgery, it can be performed at one of our adult-friendly surgical facilities or adjacent adult facilities so that you will receive appropriate operative and post-operative care. We do not usually give lollipops or stickers to our adult patients but if you ask nicely...
问：纠正斜视手术的眼部肌肉手术是否被认为是整容手术？
A：Many people believe that their misaligned eyes are a cosmetic issue and that they are being vain for even asking about it. Patients, family members, and friends should understand that there is only one normal position for the eyes and that's to have both eyes looking in the same direction at once. Anything else is a medical disorder that can and should be treated.
You communicate with people in part by looking them in the eye. If you aren't able to look someone in the eye when you talk, that makes it harder to engage attention. Patients have told me how people think they aren't telling the truth because they won't make eye contact. When your communication skills are affected in this way, so is your self-confidence and in many cases, so is your job performance.
You may be less inclined to introduce yourself to a stranger just to avoid having to worry about their reaction to your eye condition. One of my patients teaches Spanish. She came to me concerned that when she would try to look at her students in the eye to address them in Spanish, they wouldn't know that she was looking at them, and so they would not respond to her. She had to spend extra time every semester memorizing all of the kids' names before the first day of class to work around the problem. So it was impeding her work. After successful surgery, the problem went away, and now she can concentrate on all of the other challenges of teaching high school Spanish.
In addition to hindering eye contact, strabismus causes problems with eye function. As I said earlier, some adults develop terrible double vision. Others may have trouble driving because depth perception and side vision are affected. There is no doubt that the treatment of strabismus is considered a reconstructive, not cosmetic, medical intervention.
问：保险公司是否涵盖眼科手术？
A：大多数保险公司确实涵盖了眼部肌肉手术，因为这是导致功能障碍的医疗状况。一些计划需要预先授权，如果不接受手术原因，一些计划最初可能会下降。在这种情况下，我们可以直接与保险公司联系，并且经常与您联系，我们能够了解一些理解。如今，很少有保险公司不会为此手术付费。
Q: What happens during eye muscle surgery?
A：In both children and adults, the surgery is usually performed under anesthesia, although some adults prefer to be awake, and we can do that too. Once the patient is asleep, an incision is made over the white part of the eye, the muscle of interest is separated from the eye and we reattach it with tiny sutures back to the eye but in a different position. (Despite what you may have been told, there is no need to remove the entire eye to perform strabismus surgery.)
When we move the muscle to a new place it means that it either isn't pulling as hard on the eye or it's pulling a little bit harder, whichever is desired to get the eye position straight. This new positioning of the eye muscle changes the angle of the eye. For more details, seeEye muscle surgery, what to expect。
Q: What are adjustable sutures and why are they used?
A：An adjustable suture is a kind of slip-knot that holds the muscle in place. In eye muscle surgery, these sutures allow an ophthalmologist to readjust the position of the eye after surgery, after the patient has had time to wake up from anesthesia. When a patient is asleep during surgery, we can't always tell that the eye has responded to the repositioning of the muscle in the precise way we expect. When the patient wakes from surgery, we might see that the eye isn't exactly where we thought it was.
在过去，几个月后，我们将不得不重新安排另一个手术，然后重新开始。但是现在，我们可以将患者放在恢复室中，并给予麻醉眼滴。然后，随着患者醒来，我们可以以一种或另一种方式拉出那些打结，以再次移动眼睛的位置以重定向。信不信由你，这通常不会受到伤害，但是当然，患者一直担心要调整缝合线，直到他们实际经历并发现它还不错。
Q: How successful is eye muscle surgery?
A：Adjustable sutures allow us to send most patients home with their eye alignment where we want it to be. It's not always perfect though because as the eye heals, the muscle may not stick down the way we thought it would and the eye may drift one way or another.
因此，我们可能仍然让患者在手术后几个月需要再次手术。大约10-20％的患者将在第一次手术后的3-6个月内需要进行更多手术，具体取决于情况的复杂性。在大多数情况下，当它第一次不起作用时，我们等待几个月，重新评估对齐方式，然后回去重试。我们很少在随后的操作中修复它。
问：手术最严重的风险是什么？
A：患者通常最担心complications from anesthesia, but anesthesiology techniques have advanced a lot over the last 10-15 years. As a result, the anesthesiologists tell me that for a healthy patient, the risks of being injured from anesthesia are equivalent or less than the risk of being injured during a car trip.
我认为，这不是避免进行纠正手术的理由，因为发生车祸的风险，您不会开车去商店去牛奶。另一个非常罕见的并发症是手术期间眼睛本身可能受伤，这可能会导致视力丧失。这也非常罕见，就像麻醉期间受伤的机会一样。
Q: What are some other complications of surgery?
A：The main complication is that surgery might not correct the problem. Despite our best efforts and careful measurements and adjustable sutures, some patients end up needing more surgery. In some cases, that may mean you develop double vision that you didn't have before, or the double vision that you did have doesn't go away until subsequent surgery.
有时，眼睑可能会改变位置，以至于必须采取一些措施才能纠正它。偶尔会有眼睛的白色部分持续存在的疤痕，但这也很少见，除了可能必须进行多次手术的患者。
Q: Is there pain after surgery?
A：There is going to be some discomfort and blurred vision in the eye for at least a few days, but not so much that you can't function around the home. Your eye may be sore and swollen. Until the sutures dissolve, you might feel that irritation. I tell most adults to take a week out of work.
I ask that they keep water out of the eye and to use some eyedrops for a week, but there are no other limitations. Some patients are back to work in a few days, others may take more than a week if there is double vision or unusual discomfort. The redness can take months to completely resolve, but each day is a little better than the day before.
Q: My doctor told me that there is no point in having surgery, that even if it does help the eyes are just going to drift again years from now.
A：In some cases, the eyes will once again drift apart years after surgery. The surgery doesn't correct the original defect that caused the brain to let the eyes wander in the first place, so the problem might come back years later. But it doesn't always come back. In fact, most patients require just one corrective surgery over a lifetime. If it does come back, it's usually possible for a skilled specialist to again reposition the muscles and restore the benefits of straight eyes for the patient.
问：我听说肉毒杆菌毒素可用于眼部肌肉。
A：In some cases, Botox (botulinum toxin) can restore normal binocular alignment. The advantage of Botox is that it avoids traditional surgery. But its not appropriate for all cases -- you'll need to discuss this option with your doctor.
Q: I saw a web page that said that strabismus surgery only works 11% of the time and you will be blinded or killed by surgery. It said that I should do vision therapy instead.
A：The world wide web is open to all who have an opinion. We have treated thousands of patients with eye muscle surgery and most are quite pleased with the results. When we think that exercises might help, we offer that as well. We also use prisms in some cases, or Botox as I have mentioned. It depends on the patient, the patient's disposition, and the details of the condition.
Since we see a large number of patients with strabismus, we often come up with creative treatment ideas that others may not have considered. The only way to know whether surgery is right for you is to have a specialist examine you.
Q: Who do I talk to and how do I schedule a visit?
A：波士顿儿童医院的所有儿科眼科医生均评估和治疗斜视，但有些人对待更多的成年人。这些医生在//www.pphcsd.com/centers-and-services/programs/a-_-e/adult-strabismus-service/meet-the-team。