How To Fix A Lazy Eye As An Adult (2023 Update)

1.1 How Does Lazy Eye Surgery Work?

Identifying the exact deviation angle of your eyes (done by an eye doctor)
Double checking the results and clarifying any questions by the surgeon
Doing the actual surgery

The lazy eye surgery is done under general anaesthesia – and is a standard procedure.
Serious complications are rare – and very similar to other types of surgery. Here are all complications sorted by prevalence: [3]

1

100% chance of conjunctival injection

(inflammation of the eye tissue due to the surgical procedure, completely normal)

2

90% chance of visible post-operative scar

(often minor -but can be severe)

3

3.2-4.3% Corneal Dellen

(interruption of the tear film, resulting in dehydration of the eye)

4

2.1% Pyogenic granuloma

(small, raised red bumps)

5

0.4-18% Scleral perforation

6

1 in 1,500 Slipped muscle

7

1 in 4,800 Lost muscle

8

1 in 14,000 Pulled-in-two syndrome

9

1 in 1,100-1,900 Periorbital / orbital cellulitis

10

1 in 39,600 Retinal detachment

11

1 in 100,000 Risk of dying from general anesthesia [4]

The success rate of a surgery is estimated to be between 57-80%. The average prism dioptres after surgery is 6 +/- 4.9. [5][6]

Considering that recent studies indicate that 4 prism dioptres are required for optimal binocular fusion – which indicates long-term success – actual success rate may be as low as 20,4% (considering normal, gaussian distribution with above standard deviation).[7][8]

It’s an effective method, but most people will need a multitude of surgeries over their lifetime. Approx. 10% of the people who do the surgery, need to do a re-operation within a year.[9][10]

Studies on actual re-operation rate do not take into account patient satisfaction and dissatisfaction– as not all dissatisfied patients will make the decision to undergo the procedure again.

The reason for the high re-operation rate is that the procedure – from assessment to surgery – is complex. There are a multitude many potential pitfalls during this process, including:

It is estimated that human error (errors of your doctor and surgeon) are responsible for about 50% of all re-operations.[11]
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So people looking to have the surgery should pick and choose both their eye doctors - and surgeons wisely.

1.2 My experience with surgery:

I’ve had a Minimal Invasive Strabismus Surgery (MISS) in 2019.[12]

Although the surgery was done incredibly well by the surgeon - which happened to be the inventor of MISS – I would honestly not do it again.

I got zero complications and the recovery time of the surgery (2 weeks) was small, but my eyes started slipping off about 3-4 weeks later.
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“Your eye just slipped off, again.” – I still remember my brother telling me this during a family dinner. It’s a horrible feeling to hear that what you hoped would be an end of your struggle – was just a temporary relief.
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6 months after the surgery the eyes were unfortunately as misaligned as before.

1.3 Overall verdict:

Risk

Standard risk of routine surgery.

Effectiveness

Immediate results, with a relatively high short-term success rate.

Pricing

I paid about $1,000 for doctor visits, $1,000 for the surgery – and $2,400 for the insurance premium over the year. Total: $4,400. The average total cost of surgery is between $5,000 to $10,000.

Novelty

Go-to procedure. Has been around  for a while.

Effort required

A lot of upfront time and energy is required to go on consults with doctor. Then go on consults with surgeons. Then, finally, do the actual surgery. The time between the initial consult to the final surgery was ~6 months in my case.

Note from the author: I think surgery is a good method, but it should be a last resort, considering the risk involved with invasive methods. Which is why only 1 out of 20 people diagnosed with strabismus will opt for surgery. [13]

The other 19 out of 20, either try to live with the condition or opt for one of the following options:

2.1 How Does Botox Work For Lazy Eye?

Botulinum toxin gets injected into the eye muscle.
The toxin works by blocking the release of acetylcholine, thereby blocking the nerve impulse.
The given eye muscle can’t contract, resulting in (temporary) paralysis.
The paralysis of the given muscle – and therefore the changes of eye angle due to the botox injection - resolves over time (usually 2-3 months).
The botox injection needs to be repeated if the result was desirable.

2.2 My Experience With Botox

Due to high complication rate of ptosis (1 out of 3 patients), I did not try Botulinum Toxin.