Don’t Cross Off Surgery for Adult Strabismus

By Amy Geiszler-Jones
Wednesday, May 1, 2019

There is a myth when it comes to adult strabismus, commonly known as being cross-eyed, says Michele Riggins, MD, a board-certified neuro-ophthalmologist with Grene Vision group in Wichita since 2012.

Michele M. Riggins, MD, is a fellowship-trained neuro-ophthalmologist at Grene Vision Group.

“There has been a fallacy that surgery to correct adult strabismus is considered cosmetic surgery, but it’s not because it’s helpful to the patient,” Dr. Riggins says.

Correcting adult strabismus can impact a patient’s quality of life — from being able to read, watch TV or even drive again to psychosocial benefits such as improved self-confidence, better relationships and better employability, studies have shown.

Strabismus is diagnosed when the eyes aren’t properly aligned and point in differing directions, according to the American Academy of Ophthalmology. The condition occurs when there is an imbalance in the brain’s signals to the six muscles attached to each eye that control how it moves. A neuro-ophthalmologist can help diagnose and determine an appropriate treatment protocol. Dr. Riggins is one of about 400 such board-certified neuro-ophthalmologists in the U.S. and the only one in Kansas outside of the Kansas City area.

Dr. Riggins, who specializes in adult strabismus, sees about 30 patients a week who have misaligned vision, she estimates. She often sees patients who have been seen or referred by other physicians, such as primary care physicians, neurologists, neurosurgeons or other specialists, or optometrists, in the patient’s search of a diagnosis.

“My job is to figure out — if it hasn’t been already — why they have this misalignment,” she says. She also helps offer solutions.

Strabismus in adults can have many etiologies, says Dr. Riggins. It can be a recurrence of childhood strabismus or the result of trauma — including a stroke or inflammation — or a disease, such as thyroid eye disease or the chronic autoimmune neuromuscular disease myasthenia gravis. Sometimes the pathogenesis lies within the brain, perhaps because of a tumor, a cranial nerve being affected or how the brain has developed over time.

Nonsurgical and surgical treatments are available, depending on the underlying cause and severity of the strabismus. Nonsurgical treatments include observation, the wearing of an eye patch on one eye or the placement of a prism in the patient’s glasses, Dr. Riggins says.

For example, one of her patients had been able to control her double vision for a while with prism correction and occlusion, but eventually her vision impairment worsened and she became home-bound. Dr. Riggins performed a 10-minute surgery on an extraocular muscle to help align the patient’s eyes and within hours the patient saw clearly.

Among those adult strabismus cases treated surgically, more than 80 percent are successful, Dr. Riggins says.

As a neuro-ophthalmologist, Dr. Riggins also sees patients whose vision has become impaired for an unknown reason. Sometimes those cases involve underlying life-threatening causes.

For example, one of her patients thought a cataract was causing his clouded vision until Dr. Riggins discovered a brain tumor had been pressing on his ocular nerve fibers. Within days, he had surgery for the tumor.

Dr. Riggins, who completed one of the few surgical neuro-ophthalmologist fellowships in the country at Dean McGee Eye Institute in Oklahoma City, sees patients at Grene Vision Group’s Wichita and Hutchinson locations. To make a referral to Dr. Riggins for a patient with unexplained vision loss or impairment, call Grene Vision Group, 316-684-5158.

Regaining Vision, Quality of Life

Wichitan Martha Dandurand, age 76, started to retreat from her family and her life last year.

“I would just sit for hours at a time or sleep,” Dandurand says. She started missing important appointments, seemed to lose sense of time and wasn’t opening her mail. Dandurand lives with her daughter and her family, and her family members started thinking her behavior might be the result of depression or dementia.

During her annual eye exam in August, she was surprised to hear she had no vision in her right eye. She hadn’t realized the deterioration of her sight during her withdrawal, she says. She was referred to neuro-ophthalmologist Michele Riggins, MD, of Grene Vision Group, to find the reason for her vision loss.

What Dr. Riggins found not only saved Dandurand’s vision, but possibly her life. A large brain tumor was causing Dandurand’s optic nerve damage and behavior changes.

MRI multiple views, T1 and T2, showing large meningioma with significant midline shift and cerebral edema. This imaging was ordered due to the fact that Martha Dandurand had right optic nerve atrophy.

“Had it not been for that exam, this would have been life-threatening,” Dandurand says.

In December, Dandurand underwent surgery to remove the tumor.

“The most amazing thing is I’m starting to regain some vision in my right eye,” says Dandurand, who notes she’s also getting back to her old self again and interacting with what she describes as “an active household.”