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Vital Signs

Summer 2010

Eye Surgery While Awake Allows Patients to Help Surgeon


VS-Summer10-Eye Surgery AwakeA minimally invasive surgical technique to correct the double vision and crossed eyes in people with strabismus — performed under topical anesthesia with the patient awake — enables a patient to gauge the results while still in the operating room so that the surgeon can make any adjustments as necessary to ensure the best outcome.

The approach, pioneered for the last several years by Joseph Demer, M.D., Ph.D., ophthalmologist at UCLA’s Jules Stein Eye Institute, has significantly expanded the number of people with strabismus who can benefit from surgery, not only by offering a procedure without the risks of general anesthesia, but also by facilitating surgical treatment for patients with smaller angles of strabismus than in the past.

Strabismus, in which the eyes fail to line up in the same direction when focusing, is the major cause of double vision in older adults. Until now, patients with strabismus at a large enough angle have been treated with surgery under general anesthesia to manipulate the eye muscles in an effort to correct the problem. Since the result couldn’t be determined until the patient was awake, a second procedure was often required in an effort to achieve the desired outcome.

Patients with small-angle strabismus, or whose general health makes them poor candidates for major surgery, have used thick and cumbersome prismatic glasses to manage their symptoms. “These glasses are sometimes effective, and sometimes not,” Dr. Demer notes. “But even when they do help, the ability to free patients from being dependent on prisms — especially since many have had cataract and laser surgery so that they don’t need spectacles other than for their double vision — is a major benefit.”

The traditional surgical methods tended to “overshoot” the correction for patients with small angles of displacement, essentially giving them double vision in the other direction, Dr. Demer explains. With the minimally invasive procedure, instead of detaching the eye muscle completely, the surgeon can partially trim the tendons of the muscle, allowing the remaining tendons to stretch so that smaller angles of misalignment can be treated more reliably. All of this is done in 15-20 minutes, without the grogginess and bandages that come with general anesthesia. “It’s like getting a filling at the dentist — you can go right back to your normal activities later that day.”

“Many adult patients with double vision have been told that surgery is not an option,” Dr. Demer adds, “but with this minimally invasive approach they are now candidates.”

To view a video about minimally invasive surgery to correct strabismus, go to: http://streaming.uclahealth.org/strabismus

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