We finally had our first appointment for Annelisa's eyes on Tuesday, October 16. Back at her
four month update, I talked about our initial concerns with her vision. Shortly after that blog post, I began noticing Annelisa's eyes not working or focusing together more frequently throughout the day and decided to push ahead with the referral process. Dr. Starnes, Annelisa's pediatrician, recommended we see Dr. Stager, Jr. at Medical Center of Plano. I promptly called their office in early August, to make an appointment, and this was the first available!
We were very impressed with him and his awesome bedside manor! You can read his impressive bio
here.
We had initially thought that her eyes were going cross eyed, but over the last 6 to 8 weeks we've changed our thinking, she tends to have one eye at a time drift to the outside. It is intermittent during the day, but it shows itself in almost every picture I take of her shifting between both eyes.
When Dr. Stager first walked into our exam room, he noticed one of her eyes was turned out. We went over our family history, specifically how Christopher had corrective surgery for Strabismus as a 2 1/2 year old, and how he has prisms in his glasses today to continue correction. These genetics likely have an impact on Annelisa and her eye muscle development. Dr. Stager proceeded to examine her eyes by using various toys and a series of movie clips down a narrow hallway to catch her attention. Christopher said that this part of the appointment was very reminiscent of his childhood appointments with his ophthalmologist. At this point, her diagnosis was determined as Exotropia. (An information page can be found
here.) He wanted to dilate her eyes in order to measure more specifically...so Annelisa experienced her first refraction. She didn't cry when the drops were put in, but there was a lot of eye rubbing and hiding her face while we waited the twenty minutes for the drops to work. We were taken to a different room for the conclusion of her exam. She had been a really good trooper to this point, but that changed. Dr. Stager needed for her lay down so he could hold her eyes open and get a good look at each eye. I had to hold her arms and feet. She cried, pushed, and kicked at me trying to break free....for which I don't blame her! She isn't old enough to understand what is going on, and why her eyes feel funny.
Dr. Stager, Jr. then discussed with us his approach at this point and the severity he sees. On a scale of 1 to 10, 10 being most severe, he would rank Annelisa's eyes a 6...he performs surgery at 7. She will likely have surgery to correct both eyes before age one...that's less than 5 months from now. He went on to say that she has 25 to 30 degrees of refractive prism...or muscle deviation from center. The surgery will involve general anesthesia and surgically altering the muscles on each eye to cause her eyes to straighten.
It is so important for this to happen...as the information sheet he gave us explains:
The natural history is one of deterioration as evidenced by drifting occurring more frequently, to greater degrees ("further out"), and "staying out" for greater amounts of time. In the earliest stages the child may experience diplopia (double vision) but quickly the visual brain suppresses ("turns off") the image from the deviating eye resulting in the child's seeing with only one eye. ...Since precise simultaneous use of the eyes is necessary for good depth perception, there also occurs a corresponding reduction in this visual skill.
The timing of the surgery is important. As the early years are important and critical to normal vision development. The longer a child goes with this pattern of strabismus, the more difficult it is to completely cure. The immature visual brain "adapts" to this abnormal relationship between the two eyes and restoration of good binocular (use of the eyes together) skills become harder to restore. Untreated eyes drift farther and farther apart and are never "straight". Binocular depth perception is virtually lost and the abnormal appearance of the eyes becomes an increasing cosmetic and social problem for most.
We will have a follow-up appointment on November 15 to measure her eyes again. This may happen two more times, a month apart, before surgery is scheduled. He wants to monitor the rate at which she progresses and attempt to only have surgery once. At the same time, we have met our out of pocket maximum for the year with our insurance, so if he is comfortable doing the surgery before the end of the year, it would be helpful to us financially.
As in all things, I am thankful for having the opportunity to see such a skilled doctor and provide what Annelisa needs. We are praying for wisdom as we navigate these waters and to the timing of her surgery. Ultimately, the financial aspects of this process are not most important! Instead helping Annelisa develop into a healthy, strong little lady is the most important part!
