Crosslinking

“Now that I’ve forced you to spend the time listening to me explain all the things about amblyopia properly, that your previous doctors never bothered to do, either due to lack of understanding or time,” jokes Dr. Chynn, “I’m now willing to explain how I can treat amblyopia in adults!”

“Because the most adults with amblyopia had tried at least one of the above treatments in childhood, or have some vision in their lazy eye, I can improve the vision in the vast majority of adults with amblyopia,” states Dr. Chynn.

“As I mentioned above, the brain is more ‘plastic’ or adaptable than we physicians & surgeons previously thought. This is how Christopher Reeves, who played Superman in the movies, was able to regain some function in his legs after becoming totally paralyzed in a horseback riding accident. Doctors hooked his legs up to neural stimulators, similar to TENS or the (fake) muscle-building electrodes you see advertised on late-night TV,” explains Dr. Chynn. After years of this stimulation, the brain was able to make new connections to nerves so he was able to wiggle his toes

“Let’s say you have a small ocular deviation or turn, and resultant predominant strabismic amblyopia. It’s cosmetically acceptable so people don’t stare at you, but it’s noticeable to you (often women are more self-conscious of this), or becomes obvious to others when you’re tired and/or drunk (men report this situation more commonly).

“I can use my excimer laser to put a very mild prescription on that eyeball to make the eye stay straighter. To understand how this works, you’ll need to bear with me while I teach you about the ‘triple reflex’. Again, most starting Fellows in my Refractive Surgery program aren’t clear about this, so it’s understandable that no lay person (& most eye doctors, whether ODs or MDS) would be

“The ‘triple reflex’ is what allows all people to look at objects at near. Three things happen in your eyes when you look at something up close: they converge (move so they’re turned-in or cross-eyed), the pupils constrict, & a mechanism inside the eye makes it nearsighted so you things are near are in focus (this is called ‘accomodation’). All three things are linked because they’re controlled by a single ‘nucleus’ in your brain. You can’t do one without doing the other two to some extent

“I uniquely (among eye surgeons in the US) routinely employ the Triple Reflex to straighten out patients’ eyes. For example, if a patient has a mild esotrophia (cross-eyed), I put use my excimer laser you put a mild nearsighted prescription on the cornea of the turned-in eye. This decreases the need to accommodate, which in turn decreases the signal to converge—thereby helping to straighten the eye

“Similarly, if a patient has a mild exophoria (‘wall-eyed’) then I put laser a mild hyperopic prescription onto that eye’s cornea to make it mildly hyperopic or farsighted. This stimulates accomodation, which because of the Triple Reflex simultaneously triggers convergence, thereby bringing the eye in & helping keep it straight!

“I’d like to stress that excellent results can be obtained even in adults with eyes that are grossly (obviously and seriously misaligned),” says Dr.Chynn. “I’ve helped hundreds of adults who’s misaligned eyes were never fixed, usually because they didn’t have access to modern “Ivy-League quality” eye surgery as a child. Usually they were born decades ago, or in rural areas, or to non-wealthy parents, or in other, less developed countries. I’ve struck up conversations with adults on the subway, explained all of this, then referred them to a pediatric ophthalmologist who takes their medical insurance, so the straightening surgery is free! This can be truly life-changing.

“Most pediatric ophthalmologists I work with agree the proper sequence in these cases is usually for me to first do my laser, and then for them to do their muscle surgery. But in a minority of cases, the reverse sequence makes more sense.“

“If you’re an adult patient with refractive strabismus, the solution is even more straightforward. Using my unique, trademarked HD LASEK technique, I’ll eliminate your prescription in the lazy eye, after which it will actually often have a lower prescription than the other eye! After this, the brain has no choice but to pay attention to the signal from that eye!

“I’ve done this now for hundreds of patients, and they’ve been pleased with their results. Often they see better after HD LASEK treatment for adult amblyopia than the best vision they were ever able to achieve with glasses or contacts! There are many reasons why I can often make patients with refractive amblyopia see much better than they do now—and often achieve better vision than has been possible in glasses or contacts:

1. Often, the amblyopic patient has been prescribed “balanced” glasses that do not fully correct the prescription in the lazy eye, so do not provide the best vision that is possible. Why is this? Because most patients can tolerate a maximum of 2 diopters of prescription difference between the eyes. More than that causes an inability of the brain to fuse or combine the images from the two eyes due to isoconia (image size disparity). So your optometrist probably intentionally undercorrected your lazy eye—without telling you. But the excimer laser can eliminate the Rx in each eye, thereby also eliminating any isoconia. So by fully correcting the Rx in the lazy eye, rather than only partially correcting it, the excimer laser can often make lazy eyes see better than they can see in glasses.

2. Contacts don’t come in extreme prescriptions, because not enough people need such extreme corrections, so it’s not worth it for manufacturers to make such lenses. “Most contacts only go up to +3 or -9 or 2.75 diopters of astigmatism (which is another cause of refractive amblyopia), whereas I’ve seen & treated many lazy eyes between -10 and -20, or between +4 and +8, or over 3 diopters of astigmatism with LASEK,” says Dr. Chynn.

3. Many patients with a lazy eye don’t even bother to wear their prescription in that eye, since the resultant vision is still worse than in the fellow eye.

4. HD LASEK can treat many prescriptions 25x more accurately than is even possible in glasses & contacts. The increment of precision of the excimer laser is +/-0.01 diopters, whereas its +/-0.25 diopters with glasses & contacts.

5. HD LASEK puts 50 different prescriptions on the cornea, so each 1mm spot gets a slightly different prescription. Glasses & contacts treat the entire cornea with the same Rx, so they’re not nearly as accurate or precise.

6. No patient with a lazy eye corrects the Rx in that eye 24/7/365. After all, you must remove your glasses & contacts are some point. By correcting the Rx permanently with HD LASEK, the lazy eye transmits the best possible signal to the brain 24/7/365 so it can’t be ignored. Over time, the brain is essentially forced to pay attention to the formerly lazy eye more and more.

7. People with extreme myopic or nearsighted prescriptions experience significant minification in those eyes (with Rxs of -9 or worse). By eliminating these extreme prescriptions with the excimer laser, image size minification is eliminated. In effect, your image of the world looks magnified compared to before, so you can see everything more easily (because it’s bigger, not just sharper). This is how Tiger Woods won the Grand Slam of golf after he got LASIK, because in his own words “for a year it felt as it I were playing mini golf—everything looked huge: the hole, the ball, the club face all looked magnified”