PSJOURNEYS.com has a forum dedicated to not only plastic surgery, but also dental and eye care abroad. Here is a good article on one person’s experience with eye in Mexico.
Crossing over to better vision
After a lifetime of misalignment, man’s eyes in focus
By Kristi L. Nelson (Contact)
Retired pharmacist Edd Bissell, 67, had crossed eyes all his life and wore bulky prism lenses, right, in order to be able to see. Last month, Bissell learned about a surgery that could “uncross” his eyes. Now, after surgery, Bissell is seeing things in a new way. “I can’t believe how light my glasses (at left) are,” he said.
WHAT IS STRABISMUS?
* Strabismus is a condition in which the eyes are not properly aligned with each other, usually because lack of coordination among muscles surrounding the eye prevents both eyes from focusing on the same point at the same time. It may prevent someone from seeing out of both eyes at the same time, affecting depth perception. Strabismus can be either a disorder of the brain coordinating the eyes or a disorder of one of more muscles and can affect just one eye, both eyes at the same time, or both eyes at different times. A person can be born with the condition, or it can result from trauma or some diseases.
For his whole life, Edd Bissell’s vision has depended on his ability to control a little set of muscles around his eyes.
The 67-year-old retired pharmacist has strabismus, or misalignment of his eyes. Born with it, Bissell - like many others with the condition - got used to controlling those muscles in his younger years by squinting. But as he aged, that grew harder and harder for him to do. Then Bissell’s eyes would appear crossed, and if he tried to use them both at the same time, he’d see double.
“You can look at the back of my car and tell by the bumper that I have no depth perception,” Bissell said. “I either looked out of my right eye or my left eye. … Throw me a pair of keys, and I don’t know where it is. I have no conception of where it’s coming to. I might reach here, and it might hit me there.”
For about 15 years, Bissell has worn “prism” lenses - big, thick curved lenses that draw his eyes together in the correct way, enabling them to focus. They’re a nonsurgical solution to milder cases of strabismus, said optometrist Gale Roberts of Tapp Optical Dispensary, who made Bissell’s prism glasses.
“He surprised me when I first put them on him; he immediately liked it,” said Roberts, who said most patients need an adjustment period, and some don’t really like the glasses at all.
“It was immediate,” Bissell said. “It was like snapping a finger.”
But last spring, Bissell returned to Knoxville from Mexico, where he spends part of the year, unable to uncross his left eye, even with the help of the prisms. At any rate, Bissell was already wearing such thick prism lenses that it was unlikely he could support a thicker lens on the bridge of his nose.
Not only was the crossed eye affecting his vision, but “it made me self-conscious,” he said. “Because somebody’s looking at you, and they don’t say anything, but you see them go … ‘His eye’s crossed.’ You know, it’s like being one-legged, or having a wart on the end of your nose. You know people are looking at you.”
He tried in vain to get an appointment with his regular ophthalmologist group but was told he would have to wait three months. Frustrated, he asked his internist for another recommendation.
“He said, ‘You know, your prescription’s as good as it’s going to get. You need to go to Gitschlag,’” said Bissell, who knew ophthalmologist Dr. Gary Gitschlag’s name from filling prescriptions for customers. “I said, ‘He’s a pediatric guy!’”
Like many older adults, Bissell had no idea there was a surgery available that could correct his strabismus - one that had been available for decades. In Knoxville, Gitschlag is the go-to guy for repairing strabismus.
About 80 percent of Gitschlag’s patients are children; his office is in the Koppel Plaza at East Tennessee Children’s Hospital. These days, most cases of strabismus that occur from birth are diagnosed during childhood. Strabismus can also occur as the result of some diseases, accident trauma, or stroke, Gitschlag said, and since he’s known among local ophthalmologists as someone who likes to do the surgery to correct it, and is experienced at it, he’s often referred adult patients as well. Gitschlag operates on adults one day a month.
Prism lenses are often a good solution when someone’s angle of misalignment is small, Gitschlag said, but larger angles would require lenses to be so heavy it would be difficult to support them. And for some, he said, it’s a question of lifestyle; they may not like wearing glasses at all. The surgery, common since the late 1960s, won’t fix existing near- or farsightedness, but someone whose only problem is misalignment wouldn’t need corrective lenses afterward just because of the strabismus.
“A lot of folks have the impression you can’t fix (strabismus),” Gitschlag said. “It’s actually very fixable, and has been for a long time.”
The $3,000-$8,000 surgery is also covered by Medicare and insurance companies; Gitschlag does not do cosmetic surgery, so all his surgeries are coded “medically necessary,” and his office will appeal if an insurance company denies it.
In the past, strabismus sometimes wasn’t caught until a child started school, Gitschlag said, but earlier screening through the state, day care centers and civic organizations like the Lion’s Club has meant strabismus is now usually caught before school age.
“That really makes our jobs not only easier, but a lot more pleasant, because you get good results,” he said.
There are six muscles - three sets of two - around the eye that control its movement. Surgery entails lengthening or shortening one or more sets of muscles to bring one eye into alignment with the other. The trick is to get the measurements exactly right, Gitschlag said.
“Some folks have greater or lesser elasticity,” he said. “It’s not like engineering, where you can cut and measure.”
Gitschlag does six to eight of the surgeries per week and has for years, so he has some experience in measuring. It’s rare that a patient needs more than one strabismus surgery, he said.
“The surgery has a pretty good success rate,” he said.
Bissell, who had plastic surgery six years ago in Mexico to correct the sagging skin around his eyes caused by a lifetime of squinting, couldn’t be happier with the results of the strabismus surgery he had last month.
“The first day, I was dizzy as Cooter Brown,” he said. “My brain could not figure out what was going on. But every day is a little bit better.”
He only wishes he’d known years ago that there was a surgical fix for strabismus.
“If it’s no better than what it is right now, it’s OK,” he said while still healing. “It’s 100 times better than it was before.”
“Hopefully, most people won’t end up thinking that they have to wait so long to get it fixed,” Gitschlag said. “He didn’t hurt his vision at all; it’s just that he could have gotten out of having those prism glasses.”