Don't even try to talk to Gary Stuart while he's not wearing glasses, or you'll get a response like this: "I'm sorry, I can't hear you; I don't have my glasses on." That's how disorienting it is to experience the world when you have double vision. When he started seeing double as a child, it was manageable. He was given prism glasses, which work by fooling the brain into thinking the eyes are seeing one image, instead of two. As he got older, his vision worsened and his eyeglasses got thicker and thicker. "I was literally looking at the world through Coke bottles," he said.
Stuart simply learned to live with his distorted view. He never knew there was another option to eyeglasses. By the time he was in his 40s, sending in a prescription for eyeglasses was no longer an option. He had to visit the lens manufacturer in person, such was the precision required to correct his vision. Off by just a fraction, and the $400 lenses would be useless.
"This was life-changing; there is a freedom that I didn't have before." - Gary Stuart, strabismus surgery patient
"It was getting to the point that I had to do something because I couldn't carry on this way," Stuart said. At the same time, Stuart had begun working on a new life challenge, training for a triathlon. But with his double vision, it would be nearly impossible to compete in the road cycling portion of the competition. That's because maintaining a good aero position on a bike requires that the rider keep their head down and look up to view the road ahead. For Stuart, that would mean looking above the prism in the center of his glasses that correct his double vision.
"If I were riding my bike and looked anywhere but straight ahead, my eyeglass prisms were useless," he laughed. "There was no way I could participate in long-distance rides, unless I wanted to run into a tree!"
Dr. Lipsky performs an eye examination.
You're Never Too Old For Strabismus Surgery
The condition that caused Stuart's double vision is called strabismus. It’s a condition in which the eyes do not line up with one another. One eye is turned in a direction that is different from the other eye. In Stuart's case, one eye turned slightly upward. In addition, one of his eyes was much more nearsighted than the other. Strabismus is more commonly associated with children, but adult strabismus occurs at the same rate, affecting about 4 percent of all adults in the United States.
Typically, the six muscles that control eye movement work together and point both eyes at the same direction. People with strabismus can't keep their eyes in normal alignment. When one eye is out of alignment, two different pictures are sent to the brain. In a young child, the brain learns to ignore the image of the misaligned eye and sees only the image from the straight or better-seeing eye. Adults who develop strabismus often have double vision because their brains have already learned to receive images from both eyes and cannot ignore the image from the turned eye. Like many adults who have strabismus, Stuart's condition was likely left over from childhood.
"We just decided to go for it. And I've never looked back." - Gary Stuart
While surgery is more challenging in adults, eyes can be straightened at any age. In most cases, eye muscle surgery is a successful, safe, and effective treatment for strabismus in adults of all ages. The good news is that it is never too late for surgery. Even patients in their 90's have benefited from surgical correction.
That's how the 54-year-old financial planner found himself in the cheerful waiting room of pediatric ophthalmologist Stephen M. Lipsky, MD, surrounded by young children and their toys.
"At first, I wondered if I was in the right place," said Stuart. "Sitting with all of these kids in a pediatric waiting room!"
He was in the right place, and in the right hands. Because strabismus surgery is more challenging in adults than children, sometimes patients are told they're too old for surgery. But Dr. Lipsky says it's not true. "There are so many adults out there with double vision and misalignment, like Gary had. They don't think it can be fixed. Surgery is more complex. Patients are debilitated by their double vision. But it's pretty rare that we come across an adult patient who can't be helped either with prisms or surgery."
And when you can change someone's life, it's enormously gratifying, said Dr. Lipsky, who has treated a number of adult athletes like Stuart who can no longer safely engage in sports because of their double vision. "These patients have been seeing two-dimensionally, and after this surgery, everything changes for them," he said. "Many have never seen in 3-D before."
Art + Science = Strabismus Surgery
The surgical techniques used in adults are similar to those used in children: The muscle or muscles are exposed, then either weakened or strengthened as needed to properly align the eyes. For patients whose eyes turn to the right or left, surgery is fairly straight forward. But when one eye is higher than the other, like with Stuart's eyes, getting proper alignment can be extremely complex. That's where the art of surgery comes in, and the experience of the artist-surgeon.
Dr. Lipsky explained to Stuart that he couldn't guarantee perfect vision, but surgery could significantly improve his debilitating double vision. After careful consideration, Stuart decided it was time. "We just decided to go for it. And I’ve never looked back," Stuart said.
Surgery was a success. In 30 minutes, Dr. Lipsky reversed 30 years of double vision. "It was life-changing," Stuart said. "There is a freedom that I didn’t have before. Being free of glasses, frees you up, so much."
It also freed him up to pursue his goal of competing in Ironman.
Crossing The Finish Line
Nine months after surgery, he completed his first, half-Ironman: a 1.2-mile swim, a 56-mile bike ride, and a half-marathon. He finished in 7 hours and 44 minutes.
"There’s no description for how I felt at that moment," said Stuart, describing his emotions as he crossed the finish line. "I was almost in tears, to realize what I’d just accomplished. I couldn't have done it without this surgery."
After strabismus surgery, Stuart had cataract surgery. His natural lens was replaced with a special lens called a phakic intraocular lens to correct his severe nearsightedness. "To be free of eyeglasses is such a gift," said Stuart, who got his first pair of eyeglasses at age seven. "I still have a touch of double vision, but it's nothing compared to what it was. I don't wear glasses at all anymore, and I wouldn't hesitate for one second to do this surgery again."
His next goal? To complete a full Ironman event in 2018.