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Iowa City IA 52242
(319) 335-6660; fax (319) 335-8034

Release: Jan. 10, 2000

UI treats adults for eye problems often thought untreatable

IOWA CITY, Iowa -- Strabismus and certain eye muscle conditions can cause considerable functional and social problems for affected people. For years, John Danielson, 57, of Indianola, had a less common condition in which his eyes would shake and he needed to markedly turn his head to the side in order to see well.

Reading was difficult, and the condition made Danielson self-conscious when he had to speak publicly. However, more adults like Danielson whose eye problems were not treated in childhood are finding help from University of Iowa Health Care ophthalmologists.

On referral from Thomas Brown, M.D., a West Des Moines ophthalmologist, Danielson had corrective surgery at the UI last October. He now enjoys vision that allows him to read with ease and look directly into his wife's and five children's eyes while keeping his head straight.

"I reaped some major benefits," said Danielson, who is a communications engineer for the Iowa Communications Network. "The treatment really improved my quality of vision. I noticed the difference within a couple of hours after surgery."

William E. Scott, M.D., professor of ophthalmology and a nationally recognized strabismus researcher, performed the operation -- one of nearly 450 strabismus cases seen each year by physicians in the UI department of ophthalmology and visual sciences. In a three-hour outpatient procedure, Scott cut muscles in Danielson's eyeballs and reattached them to correct the marked head turning problem. On his way home later that day, Danielson read a magazine in the car.

"Correcting John's abnormal head posture made a great difference in his life," Scott said. "The treatment is not simply cosmetic but restorative. Eye muscle surgery can provide functional gains, restoring the field of vision or simultaneous perception as in the case of cross-eye or walleye."

In strabismus, poor eye muscle control causes a lack of coordinated eye movement. The eyes turn inward in convergent strabismus, causing "cross-eye." In divergent strabismus, the eyes diverge, causing "walleye." Other forms of strabismus can cause double vision. Left untreated, a child may favor the unaffected eye, which can cause the other eye to get even worse. Strabismus affects up to 4 percent of the general population.

A good number of adults with strabismus were born with eye alignment deformities or developed them later in life. For various reasons adults are often told the condition cannot be treated, or treatments are not available at their age, Scott said. However, many cases now are treatable.

"It's a myth that strabismus can't be corrected with good results even in adults who grew up with the condition," Scott said. "We may not be able to correct a condition 100 percent, but upon evaluation, we can let a patient know what is possible."

Danielson's parents took him to the UI in the 1950, when he was 8, but treatments were not available then, and he had to learn how to cope with the disability.

"I would turn my head to where the eyes were steady and quiet," he said. Although his distance vision was not a problem, his close vision activities were compromised enough to affect his everyday life. He recalls that schools in the 1950 did not really know how to help students like him.

Scott said that studies associate stress with strabismus. In our culture where direct eye contact is expected, a schoolteacher or work colleague may mistake a "sideways" look for inattention or even disrespect.

Today, nearly 40 percent of patients treated for strabismus at the UI are age 9 or older. Strabismus is hereditary but also can be caused by accidents, such as a motor vehicle crash, in which a person takes a severe blow to the head. In rare cases, strabismus can be a precursor to a more serious condition such as eye tumors.

As with most medical procedures, there are a few risks and side effects to strabismus surgery. Scott said physicians are careful to take precautions to prevent infection in a patient's eyes and, in some cases, a second or even third procedure is necessary. After surgery, the eyes are usually sensitive to light, feel gritty and sore due to stitches, and appear bloodshot. It can take up to one year for the "white" of the eye to fully regain its proper color.

Scott said some individuals who receive strabismus treatment complain of double vision after surgery, but a study found that less than 1 percent had the same complaint three years later.

Danielson, who has no double-vision problem, said the post-surgery discomforts were worth it to stabilize his vision.

"There was some adjustment since I had been looking off to the side for 57 years," he said, "but now I don't have to think about holding my head a certain way to see straight. It's fantastic."

As with all medical conditions involving the eye, talk with your ophthalmologist or other eye care professional if you have strabismus or any sudden onset eye problem.

For more information about strabismus treatment at the UI, call (319) 356-2859.

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.