Treating Pediatric Strabismus
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Anonymous
| Does anyone have experience with treating pediatric strabismus with Botox injections? We're considering it for our daughter who is nearly 3. |
Anonymous
| uh, no, never heard of that! who's your doc? |
Anonymous
| i haven't heard of treating it this way either. i recommend dr. michael repka at wilmer eye institute at hopkins for a second opinion. |
Anonymous
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My DC has had 2 surgeries for strabismus in both eyes. Recovery was pretty easy. The surgeries were successful, and permanent. My understanding is that that botox wears off and may need to be repeated a couple of times a year. I think it would drive me batty to wonder if the botox was wearing off. My DC's poor vision affected her life negatively in a thousand little ways. We didn't realize the extent of it until her eyes were fixed. After surgery, her social skills, motor skills and academics took off like a rocket.
If the doctors' opinions are that the botox will be a permanent fix, then I'd consider it. |
Anonymous
| Our fabulous doc is Dr. Melissa Kern out of Arlington & Sterling and Botox has never been mentioned as a treatment option. Not sure how I would feel about injecting dead botulinum toxin into DC's face (now for myself on the other hand...) |
Anonymous
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Thanks for the feedback. We see Dr. Vicente in Chevy Chase. As he explained it to me, the probability of success with either treatment is about the same and we can move on to surgery relatively quickly if Botox doesn't work.
I did attempt to get a second opinion from Dr. Repka at JHU but he has no appointments available until next year. We're going to see another (newer) doctor in his group next week. From their website, it does appear that they are familar with the Botox treatment. |
Anonymous
| We see Dr. Vicente and he's disucssed this with us and given his amazing reputation, we are considering this option for our little one. There is some great research out there (including Children's of Boston http://www.childrenshospital.org/clinicalservices/Site1340/Documents/Ophth-WTE-%20BOTOX%20Treatment.pdf) |
Anonymous
| Glad you are looking into Wilmer. FYI, your pediatrician may be able to get you a quicker appointment with Repka. |
Anonymous
| OP, any updates on your plan? I'm 20:15 poster and we are scheduling the procedure for December |
Anonymous
| Out of curiosity, today I asked Dr Madigan, chair of optho at Childrens,, about possible botox injections as we were discussing surgery for my DD's strabismus. He didn't recommend it all - could wear off and bits of the botox could affect the eyelids by mistake. I get the feeling that he has no experience with it but has tons of experience with surgery so he's pro-surgery. We're going to Dr Vicente for a 2nd opinion before surgery and will ask him about botox. One question I have: is botox an option when the problem is the eyes float outward (exotropia), not inward (esotropia)? |
Anonymous
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Dr. Vicente performed this procedure on our daughter. Yes, she did get some eyelid droop but it passes once the Botox works its way out of her system. We're not far out enough from the procedure to judge it yet, but Dr. V is pleased with what he sees thus far. We went with it because it is less invasive, surgery is still an option later if necessary, surgery leaves scar tissue that can be a problem later, and surgery doesn't always work. Yes, it is possible that Botox will have to be repeated but that's also possible with surgery--I know a couple of people who have had a few rounds of surgery.
But, must also say that each case is different and I'd be guided by a medical professional first and foremost. |
Anonymous
I can't imagine having a child with this disorder and not going to Wilmer to at least get second opinions, if not the complete repair. It's only 45 minutes up the Interstate (or less if you can get an appointment at Green Spring Station), and the doctors there are THE BEST in the world. If Dr. Repka isn't available, try to see Dr. David Guyton -- http://www.hopkinsmedicine.org/wilmer/employees/cvs/Guyton.html I speak from first-hand experience (I was the patient and had adult strabismus surgery). They treat you like royalty at Hopkins and the results speak for themselves. |
Anonymous
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My 7 yo had her second surgery two months ago @ Children's. It was tougher than the first, which was done at age 4. They had to cut through scar tissue and do more agressive adjustments to more muscles. It was a tough first week of recovery and has slowly improved from there. Her vision still isn't perfect but it much better. I won't be surprised if the docs recommend a third surgery in a few years. She seems to have a stubborn case.
Thanks to the PP who shared the link to Johns Hopkins. I'd like to take my DD there for a 3rd opinion in the future. FWIW, Dr Vicente said that the Hopkins doctors are the quickest to advise surgery, Children's Hosp doctors are second, and he is last. He likes to try Botox first, though he said my DD's case was beyond Botox, surgery was the only option. Overall, we've had a good experience at Children's, though the waiting rooms are chaotic. |
Anonymous
I have to second Dr. Guyton. He is one of the most knowledgeable and caring eye docs out there. I contacted him upon someone's recommendation, and he was very diligent with my eye exam. I have a feeling he is on a conservative side when it comes to new eye treatments, which I liked - often times you don't know what the long term consequences are and you can't reverse what's been done....Good luck! |
Anonymous
10:49 here again... The beauty of David Guyton is a) he's a wonderful doctor to deal with (he tends to run behind in his appointments, because/however when it's your turn, you will get the best possible service and an unsurpassed level of attention to you and nothing else), b) he knows his stuff perhaps better than anyone else in the world, and c) he has an artist's touch and can make the right judgment calls based on instinct and the experience of having done probably tens of thousands of surgeries, which is absolutely critical when you're talking about doing something like detaching a muscle from an eye, moving it over a couple of mm, and then stitching it back on again. Remember when the US Airways pilot landed the plane in the Hudson River last year and everybody talked about how he was the perfect person to have been at the controls, because the slightest mistake in any number of parameters could have meant the difference between success and a much less pleasing outcome, and because only a handful of pilots in the world could have pulled the whole thing off the first time? Well, that's the way David Guyton is when it comes to eye muscle surgery. |