{"id":79679,"date":"2025-01-13T13:33:52","date_gmt":"2025-01-13T20:33:52","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=79679"},"modified":"2025-01-13T13:33:52","modified_gmt":"2025-01-13T20:33:52","slug":"correcting-misaligned-eyes-a-fathers-success-with-adult-strabismus-surgery","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/correcting-misaligned-eyes-a-fathers-success-with-adult-strabismus-surgery\/","title":{"rendered":"Correcting misaligned eyes: A father’s success with adult strabismus surgery"},"content":{"rendered":"
<\/div>
\"Stefan
Stefan Garman\u2019s eyes are back to normal after successful surgical treatment for adult strabismus at UCHealth University of Colorado Hospital. Photo by Sonya Doctorian, UCHealth.<\/figcaption><\/figure>\n

Stefan Garman worked his University of Colorado IT job from home in west Denver during the coronavirus pandemic, but he was on the road a lot. He and wife Ashley had bought a house in Centennial, and he drove back and forth daily during prolonged renovations.<\/p>\n

It was during those trips that he gradually noticed something was out of alignment. It wasn\u2019t the wheels of his vehicle, but rather his eyes.

Are you experiencing vision loss or other eye problems? Not all vision problems originate from your eyes. Some arise due to disease or damage that affects the brain or the optic nerve. Learn more about neuro-ophthalmology and different conditions<\/a> and find a specialist near you.<\/div>\n

Garman, now 38, was slipping into adult strabismus, which 4% of us will experience in our lifetimes. Also known as \u201ccrossed eyes,\u201d it started with blurred vision that blinking and concerted focusing could address. But the problem worsened into double vision, and then, as he put it, the perception that \u201concoming traffic is coming right at me, because my right eye is pointing off to the side.\u201d<\/p>\n

He was prescribed prism eyeglasses, and they helped, but his distance vision kept deteriorating, and the little annoyances associated with his adult strabismus kept mounting. His 5-year-old son Braden would toss him a ball he couldn\u2019t catch with his glasses off. He couldn\u2019t recline sideways and watch TV with them on.<\/p>\n

\u201cThere wasn\u2019t some big detriment to my life, or major things I couldn\u2019t accomplish because of my vision,\u201d Garman said. \u201cBut there was a cumulative impact of those hundreds of little moments that I couldn\u2019t fully appreciate because I couldn\u2019t see past three feet.\u201d<\/p>\n

Adult strabismus usually starts in the brain<\/strong><\/h2>\n

In 2023, he got an appointment with University of Colorado School of Medicine neuro-ophthalmologist Dr. Prem Subramanian<\/a> at the Sue Anschutz-Rodgers Eye Center<\/a> on the Anschutz Medical Campus<\/a>.<\/p>\n

\"Garman
Before Garman\u2019s surgery, his wife Ashley was the family’s designated driver after dark. Photo by Sonya Doctorian, UCHealth.<\/figcaption><\/figure>\n

Babies can be born with strabismus; with adults, it can have many causes. Adult strabismus can emerge from a recurrence of childhood strabismus<\/a>, or it can be associated with stroke, multiple sclerosis, brain tumors or trauma, or surgical or medical complications, among other reasons. The root cause, Subramanian said, is typically neurological \u2013 that is, in the brain. Strabismus usually happens when the brain\u2019s commands to one or more of the six muscles<\/a> that control an eye\u2019s movements strays from its proper duties and the eye slips into misalignment that won\u2019t ever correct itself on its own.<\/p>\n

In Garman\u2019s case, testicular cancer and treatment that wrapped up a year before his adult strabismus symptoms developed may have played a role, Subramanian said.<\/p>\n

\u201cWhen people get sick, sometimes that\u2019s a trigger for the brain to no longer compensate for a tendency towards having an eye misalignment,\u201d Subramanian said. \u201cSo, your body gets thrown for a loop, and your brain says, \u2018You know, there\u2019s only so much I can do at one time, and controlling your eye movements isn\u2019t something I can do anymore.\u2019 And then it lets that misalignment become manifest.\u201d<\/p>\n

Surgical treatment for adult strabismus focuses on the eye muscles<\/strong><\/h2>\n

The diagnosis involves investigations into both eyes. Some patients receive lab testing for underlying diseases or conditions such as thyroid eye disease<\/a>, myasthenia gravis<\/a>, diabetes, or hypertension. CT or MRI scans of the structure of the eye socket, muscles, and nerves can also come into play, Subramanian said.<\/p>\n

\"Dr.
Dr. Prem Subramanian<\/figcaption><\/figure>\n

In Garman\u2019s case, the diagnosis was straightforward, and so was the solution: corrective surgery. In theory, the idea is similar to that of an automotive wheel alignment: get things pointed in the same direction. In practice, the surgery involves science as well as art.<\/p>\n

While adult strabismus\u2019s causes are typically in the brain, it\u2019s not brain surgery. Rather, it\u2019s about adjusting the length or strength of eye muscles such that the brain\u2019s commands, faulty as they may be, still align the eyes. That can happen in a couple of ways.<\/p>\n

One is to detach the muscle from its anchor on the eyewall and reattach it nearby. That changes the starting position of the eye as well as the degree of eye movement an eye muscle\u2019s contraction brings about. Depending on where it\u2019s reattached, that can either lessen or boost the muscle\u2019s effect on eye movement. An adult strabismus specialist such as Subramanian can also shorten, and thereby tighten, a given eye muscle by cutting a bit off it or folding the muscle over on itself.<\/p>\n

While ophthalmologists have established systems to determine what muscles might best be adjusted, how, and by how much for a given case of strabismus, there\u2019s more to it than the mechanistic alignment of a car\u2019s front wheels.<\/p>\n

\u201cIt really depends on a particular patient\u2019s condition, and that\u2019s part of the experience and art in doing this,\u201d Subramanian said. \u201cWith certain diseases, such as thyroid eye disease, we almost always weaken the muscles, because they\u2019re already a bit tight. But in other conditions, you have the option of either strengthening or weakening the muscle.\u201d<\/p>\n

A year out, most adult strabismus surgery patients are home free<\/strong><\/h2>\n

Because most of us have a dominant eye, adult strabismus patients often perceive just that eye to be the issue. But adult strabismus often affects both eyes, and so it was with Garman. Subramanian determined that lengthening the medial rectus muscles of the nose-side of both eyes would be the best approach, and, in early 2024, that\u2019s what he did. The realignment was an immediate success.<\/p>\n

\"Stefan
Stefan and Ashley enjoy their after-school walk with son Braden, 8, in their Centennial neighborhood. Stefan handles Toby and Ashley takes Loki. Photo by Sonya Doctorian, UCHealth.<\/figcaption><\/figure>\n

\u201cI came home that night and sat down and watched TV without my glasses, and I was like, \u2018Oh my God, this is incredible,\u2019\u201d Garman said.<\/p>\n

His recovery went smoothly. He took a couple of days off work and used over-the-counter tear-replacement drops for about a month because his eyes were temporarily drier than normal.<\/p>\n

Garman had his final follow-up appointment with Subramanian in late November.<\/p>\n

\u201cIf people are doing well about a year out from the surgery, the chances are good that they will continue to do well,\u201d Subramanian said.<\/p>\n

In the meantime, Subramanian and CU School of Medicine colleagues specializing in neuro-ophthalmology and pediatric ophthalmology are establishing a formal adult strabismus practice at UCHealth to unify their work in treating hundreds of children and adult patients a year.<\/p>\n

Garman\u2019s on the road less since his family\u2019s move to Centennial. If alignment\u2019s an issue when he is, it\u2019s about the potholes.<\/p>\n","protected":false},"excerpt":{"rendered":"

Stefan Garman worked his University of Colorado IT job from home in west Denver during the coronavirus pandemic, but he was on the road a lot. He and wife Ashley had bought a house in Centennial, and he drove back and forth daily during prolonged renovations. 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