Dear Dr. Roach: I am a 65-year-old woman. As a child, I had what we called “lazy eye.” My condition was that my right eye was aligned noticeably outward. I believe this is referred to as “exotropia.” I had surgery to correct it at the age of 12, and surgery was successful — my right eye has remained in proper alignment since then. As an aside, an aunt on my father’s side had the same condition, which was never corrected. By the time she was in her 70’s, her right eye was always pointed to the far-right side. As kids, we didn’t know that she had a “good” eye, so we never knew who Aunt Grace was talking to!
My son, now 32, had the same condition as a child, and also had surgery around the age of 12. It was successful at the time, but in the past year or so, we are noticing that his eye is once again drifting to the outside.
He has been hearing and reading about a new therapy using virtual reality screens and exercises to retrain the eye. When I look online, I find many ads and “informational” websites by the companies that offer the therapy and the equipment for this treatment. I find very few plain-language medical websites that discuss the process, the safety or the effectiveness of this type of treatment. What do you know about it? Are there other effective nonsurgical treatments for adults?
Strabismus is the general term for a “lazy eye” where the gaze of the affected eye points sideways. “Exotropia” for pointing to the outside; “esotropia” for pointing inward. Symptoms can include double vision, headache and eye strain. Symptoms are an indication for treatment. Although surgery is one common treatment, not everyone needs to be treated, and there are nonsurgical alternatives. Passive vision therapy, such as putting a patch over the unaffected eye, is a time-honoured technique in children, though I could find little about it in adults. Active vision therapy — the eye retraining techniques you mention — has also been tried and shown to be effective in children up to 17 years. Another study showed that orthoptic exercises are as effective in adults as they are in children at relieving symptoms.
New onset of inability to move the eye to one side could indicate a serious problem with the nerve to the eye, so should be promptly evaluated. Longstanding problems with strabismus should, of course, be referred to an eye doctor.
Dear Dr. Roach: Recently you wrote about some health risks associated with smoking and vaping of cannabis. I was wondering if you could comment on any health risks that might be associated with edible consumption.
Edible forms of cannabis (gummies seem to be a popular choice) do not have the potential for harm to the lungs that smoking and vaping do. However, the onset of action is slower than those other methods, and inexperienced users can sometimes take too much while waiting for the desired effect. For this reason, visits to the ER for toxicity for edible forms of cannabis are higher than would be expected.
Cannabis in general has few adverse effects; however, changes to short- and long-term memory are possible in heavier users, and use by adolescents is associated with a higher risk of schizophrenia. I also mentioned an uncommon side effect, cannabis hyperemesis syndrome (periodic uncontrollable vomiting), in a recent column.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu
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