The College of Optometrists

female px aged 45

has a constant angle 15XOT distance and near

shallow suppression in non fixating eye

6/5 R 6/6 L

Not having any problems but wonders if anything can be done to improve her vision.

Would anyone consider using prism in an attempt to restore binocular single vision?

is referral for surgery appropriate?

This lady is probably happy with VA. She may not be cosmetically so.

If you attempt to alter squint angle shed probably have diplopia and she is very unlikely to have had any binocular vision ever so would not get BSV.

Surgeon would probably get annoyed with a referral like this on visual grounds.

Pswould youl like to wear 15 prism diops??

Correction (prisms, overminus if younger, or surgery) of the EXOT will only be of benefit if binocularity improved.

If there is no improvement, i.e. global suppession remains, when the EXOT is corrected with prisms, then as well to leave.

Why surgery ? Although it could theoretically align the eyes(but accuracy may not be good enough in this case), it would not alter the ability to achieve binocularity. Moreover, the cosmetic appearance of the EXOT is not an issue.

PS - If Px is having no problems, think carefully before introducing one.

reading this reminds me of a px who did have an alternating exot squint correction in her late forties. The op. was trouble free and she was pleased cosmetically for the first year, but then the strab reappeared. She was a nightmare for glasses as she could switch eyes and became very fussy. On the whole; her and I came to the conclusion that it was not worth it.

The professional way is to do what you have to do to help the px - and leave the rest alone:the conservative approach