Anna's Eyeballs: The Update

Well, if you've been paying attention to my Facebook posts, previous blog post, or have actually seen me in person over the last month, you've probably heard me talk about my daughter's eyeballs.

She's really stinking cute, which makes the issue that much more difficult. So I'm pretty much going to pick up where I left off on my last post. I recommend reading that if you have no idea what I'm talking about here. It can be found here.

Anna's eyes are in fact going to require surgery to correct the problem of them being crossed. The patching did not correct the cross eyed problem, however, we have noticed that she does favor her left eye from time to time.

I'll be quite honest, we knew it was coming, we had done our homework and knew the problem wasn't going away. However, I hadn't quite braced myself for the REALITY that would set in the moment we left the Dr's office. I nearly got emotional enough to almost cry. I know, pretty wimpy of me isn't it. 

I think the thing that gets me the most emotional is the thought of when they will take her away to do the surgery. Either when they take her away, or when they put her under is going to be rather traumatizing for me as a father. I just can't stand the thought of causing her any pain. Ok...NOW I'm officially shedding a tear or two.

I would like to ask everyone that is reading this to please pray and fast for our little girl. We will be holding a family and friend fast on Sunday, September 22, 2013. And we wouldn't mind a prayer or two in our direction for us dealing with this...you know...emotionally.

Now, if you have any indication of concern for this adorable face (or one like it), you're going to be asking some of the same questions we did ask the doctor.

Q: Where will the surgery take place?
A: There is a small clinic in Provo that will provide the venue.

Q: Who will perform the surgery?
A: Dr. Yeates, an MD specializing in "pediatric opthamology and adult strabismus" (strabismus is where the eyes cross)

Q: How many times has Dr. Yeates performed the surgery?
A: Dr. Yeates said that he lost count of how many times he had performed the surgery. He does it at least 5 times each week. He said likely over 800 times.

Q: What is the root cause of the problem? Is it genetic?
A: There really isn't a known root cause. Many doctors-Dr. Yeates included believe that it's some disconnect between the brain and the muscles, however, other very reasonable theories exist.

Q: What are the risks?
A: The greatest risk is the anesthesia. Ensuring that Anna isn't sick before the surgery is important there. The most common risk, however, is infection (1/20,000 cases). There are minor risks that the eyes will bleed too much, or could have some other damage incurred on them.

Q: What is the typical age for the surgery?
A: Anna is on the young end for doing the surgery (9 mos). This is both a blessing and curse. A blessing because we caught it quick and so action can be taken. A curse because children demonstrating this problem this young, typically require a second or third surgery some time in their life. Now, the time span of that second surgery is very broad, but at her age it's about 1/3 to 1/2 cases requiring surgery a second time.

Q: Will there be any required medication after the surgery?
A: Eye drops will be prescribed. These eye drops will prevent infection.

Q: How does insurance work with the surgery?
A: Insurance treats this a required surgery- not cosmetic. So it will be fully covered.

Q: Do we need to patch after the surgery?
A: NO! The eyes should be exposed as much as possible to allow her brain to begin sorting out vision with two eyes. To this point, she has only used vision in one eye at a time.

Q: How regularly do we need to do checkups afterward?
A: Every few months for the first year or so. If things go well, visits will reduce in frequency.

Q: How soon after surgery for first follow up?
A: Less than 7 days.

Q: Do we need to patch in the meantime?
A: Absolutely yes! She needs to get used to having that eye have vision in it.

Q: How much does it cost?
A: This is something that we didn't have information available at the time. When we get the information, I'll post it here. I'm expecting around $2-3k for "pre-insurance" cost.

Q: Do we need to keep her from rubbing her eyes before/after the surgery?
A: Dr. Yeates said that expecting her to keep her hands off of her eyes is completely unreasonable, and unnecessary. The best thing we can do is to make sure she isn't submerged in water.

Anna's Eyeballs

If you haven't noticed, our little girl, Anna, has a bit of a problem:

She's cross eyed. 

So there's really a couple of things that could be going on here. One it could be a lazy eye.  This is less likely because the doctor says that both eyes are turning in toward her nose.

The other thing that it could be is her eye muscles with a condition known as medial rectus recession. This is much more likely. The doctor says he is 80% sure it is this condition. Basically here's what it is:

There are 6 muscles in each eye:

Here's what I interpret for what each eye muscle does

1. Superior Oblique-Stabilizer rotationally
2. Inferior Oblique-Opposite stabalizer
3. Superior Rectus-Look up
4. Inferior Rectus-Look down
5. Lateral Rectus-Look away from nose
6. Medial Rectus-Look toward nose

So basically, the last muscle, the "medial rectus" is the culprit. The problem is that it is too tight. The problem is in BOTH eyes, not just one. When you look at her or many other kids with the same problem, they favor one eye (in Anna's case the right). So when she looks at you, she looks with her right eye, but the left can't quite make it there because the muscle is pulling too tight.

One thing that you'll notice is that if you are standing to Anna's right, she'll usually turn her head to look at you. Whereas if you stand to her left she'll turn her eyes to look at you. This is one of the indicators apparently.

So both eyes are turned in toward her nose, and this makes her look cross eyed. So what? So my kid looks funny, no big deal right? She could have inherited more of her daddy's looks and then she would look really funny. Things could be worse.

The real issue is that if we don't take action, she may eventually lose vision in her "unfavored" eye, aka her left eye.

At our visit with the doctor on Thursday (July 25th), he said he wanted us to patch her eye for 2 hours each day for one month. It's really sad (particularly the cry after we pull it off).

The patch will help keep the vision in her left eye up to snuff, and also will rule out any other miscellaneous causes of her eyes being crossed. If in one month, we do not see any improvement in her eyes, we will have to go forward with surgery.

So what do they do then? The doctor described a relatively simple surgery to counteract the effects. He said that the surgery takes place thousands of times per day in the US, and takes under an hour to complete. Basically it is moving the attachment point of the muscle, or weakening the muscle in such a way to allow more outward movement.

The surgery is supposed to turn this:

Into this:

Much better right?

So I've been fishing through resources online to learn more about this surgery, the condition, and how we can help. Honestly, the biggest concern for me is the anesthesia. 

If you're interested, here's a link to a text/picture description of how the procedure is performed: Text Description

And for those who like the more graphic video of it here it is for you: Here and Another

The doctor said that older children (3-4) say that the only pain they feel afterward is sort of a "muscle soreness" in their eyes. Her eyes will be a little red for 7 to 10 days after the surgery, but other than that, in, out and done.

Overall, we're really concerned about our little girl.  We want her to get better, and if it requires this surgery, so be it. Please keep her in your thoughts and prayers.