Eyes and Ears

Rosalie had appointments last week with the audiologist and the ophthamologist.

The audiologist saw no change in the hearing in her right ear and a slight change with her left ear. We are just crossing our fingers that everything stays status quo so that she doesn't need a hearing aid.

The ophthamologist explained that Rosalie's eye turning inward (strabismus) will most likely require surgery or Botox in the future. No decisions will be made until she is done with chemotherapy. Until then we are patching her eye for about an hour a day to make sure her brain remembers to use the left eye. My friend Stacy is finishing her residency in ophthamology, and I thought those of you who like the details might want to see her responses to my questions. She explains everything so well. Thank you, Stacy!

Q & A
> (a) Is it possible for Rosalie's eyes to get better when she is done with chemo?
Without examining Rosalie's eyes myself, I do not know if her strabismus is due to a cranial nerve palsy from the tumor or the surgery, or if it is more of a simple esotropia. In either case, I doubt that her eyes will self-correct. But, strabismus is a very common problem and most children have excellent outcomes after the surgery (which is short and safe), so you should not be too worried about the long term outcome (especially after all that she has been through!).

> (b) Can the Botox cure the strabismus?
Botox is used to sort-of paralyze muscles. If you paralyze the muscle that pulls the eyes inward, then there will be less force in that direction, and the eyes will be pulled outward by the opposite muscle in the eye.

> (c) How effective is the strabismus surgery (I think he said bimedial recession)?
I don't know which doctor you are seeing or the details of Rosalie's case, but most strabismus surgery is effective ~70-80% of the time. In the 20-30% of children who aren't aligned after the first surgery, a 2nd surgery usually works (80-90% of those 20-30%). It really is a safe procedure for the eyes and is very commonly done (at my eye institute, we probably do ~15 strabismus surgeries each week). If you want a 2nd opinion, I could arrange one at UCLA (but I don't think you need to do that UCSF is really excellent!).

> (d) Is it common with strabismus that the eye goes in sometimes and stays straight at other times?
Yes - it is common, and is actually really good. The times when her eyes are straight, she is using them together. When she uses her eyes together, her weaker eye is developing good vision, and she is developing binocular vision (depth perception). At times when her is in, she is only using the stronger eye and is not gaining depth perception. I think the patching is very important until the strabismus is addressed with botox or surgery.