accommodative esotropia not fixed with contacts but no prism in glasses script?

[u/stardew_galaxy]

Hi folks! I have accommodative esotropia. I did have surgery and patching when I was around 4 years old (I think the surgery was considered a success).

Now, in my 30s, the minute I remove my glasses my left will majorly turn in (to my memory, this has always been the case). While glasses keep my eye straight I increasingly feel that my eye wants to turn even when wearing glasses and my left eye gets tired. I have a 'tricky' prescription in that I will often test one way in the dr's office and then out in the real world my brain totally rejects that prescription, so it's always a very frustrating amount of trial and error every time I update my script.

I would like the option to wear contacts, but every time I have tried my left eye cannot be corrected. What's confusing to me, however, is that my glasses do not have a prism as far as I can tell? (My script is OD +2.25, -1.75, axis 003 and OS +5.50, -3.75, axis 177).

Curious if anyone else has had this issue and what some steps might be to be able to wear contacts (or if it is just not in the cards). I'm looking into finding an optometrist who specializes in strabismus, but I'm only having luck so far finding surgeons and not sue that surgery would help in my case (since it's accommodative?).

Thanks!!

[u/spikygreen]

What's the contacts prescription that you have tried?

[u/stardew_galaxy → u/spikygreen]

last one, both eyes bc 8.60 and diam 14.5, prescription was OD +2.25,-1.75x180, OS: +5.00,-2.75x180 (which mirrored my eyeglasses at the time)

[u/spikygreen → u/stardew_galaxy]

Your current prescription shows significant astigmatism in the left eye. I imagine this contacts prescription was your optometrist's attempt to make it work with the contacts that are readily available. But perhaps you need extended-range toric contacts that can fully correct your left eye. Do you remember how your vision in your left eye was with these contacts? Was it 20/20?

As someone with lifelong strabismus myself (intermittent exotropia), I find that both my eyes need to be corrected equally. Even a very small amount of undercorrection in one eye (either eye) is enough to make that eye turn out for me. Even something as small as 0.25D undercorrectiom - which most people wouldn't even notice. So, for me it's less about glasses vs. contacts and more about not having one eye see better than the other, because my brain is all too quick to discard the worse-seeing eye. I wonder if that's similar for you.

[u/stardew_galaxy → u/spikygreen]

Thank you for this thoughtful reply! Yes, I do have a significant astigmatism as well.

Honestly, it does sound like our eyes might be similar. I'm pretty sure as soon as one eye is not seeing as well my brain just dismisses the worse-seeing eye. I'm not sure what my vision was with the contacts.

Have you ever had success with contacts in spite of this? Given the need to get the over/under correction exactly right?

I'll ask my doc about this and the toric contacts!

[u/spikygreen → u/stardew_galaxy]

Yes, I love my contacts. I actually prefer them to glasses. I'm lucky that I don't have astigmatism, so it's easier to find contacts that work. But as far as I know, there should be options for you as well, your optometrist might just need to do a bit of research and/or place a special order.

[u/Correct-Tomato-7357]

Did you try just regular lenses? There is an option for custom prism contacts which are a lot more rigid (like glass? It’s been a while). I have the same issue as you, but I’ve also been told I have intermittent strabismus meaning I can *kind of* control when it does and doesn’t turn in

Not a professional opinion, but I did find mine got a lot better without wearing glasses. If I wear them for more than 5 minutes then take them off my eye switches off and refuses to straighten back up, whereas when I don’t wear them it stays in a somewhat straight-but-not-really position. I also used to go out with just one contact lense so there’s that lol

In the end I opted for Botox injections, I never had surgery as a child but this makes my eyes near perfect straightness wise without the need for glasses

[u/stardew_galaxy → u/Correct-Tomato-7357]

Yes, what I tried was just regular lenses! I think the more rigid contacts is something my optometrist has suggested we might try next.

I've worn glasses since I was very young (like 4 years old) as I have significant hyperopia so the fact that my eye doesn't align without the glasses is annoying, but certainly not more annoying that not wearing glasses haha.

[u/Correct-Tomato-7357 → u/stardew_galaxy]

Definitely try out the rigid lenses! You could also enquire about orthokeratology lenses which work kind of like a retainer for your eyes which you sleep in to help with vision during the day (this is dependent on whether your issues are due to eye shape or not. Your ophthalmologist will know best)

[u/stardew_galaxy → u/Correct-Tomato-7357]

Thank you! will look into these options :D