Sweet Pea's Eye Muscle Surgery

Role-Playing "Dr. Reznik"

My daughter's eye muscle surgery was scheduled for November 15, 2012. About a week before, I listened from the other room while my husband talked with Sweet Pea about the upcoming event. He explained that we would visit with the doctor first, then she would lie down and a doctor would cover her nose and mouth with a mask to help her fall asleep. Our daughter is very curious and already enjoys playing doctor, dentist, and orthodontist, so she was intrigued. They role-played a little bit, then it was bedtime.

I think my husband initiated this discussion to help prepare all three of us for the surgery. Indeed, he and I were probably more anxious about it than she was. Little did he know that playing "Dr. Reznik" would be Sweet Pea's favorite activity that she would want to play with each of us several times a day up until the date of surgery (and for several weeks afterwards). I just hoped we were being accurate enough in our play that she wouldn't be too upset by any changes in the game when it happened for real. I could just imagine her telling the doctors that they weren't playing properly.

Pre-Op: Parents Nervous; Daughter Cool as a Cucmber

We drove to Portland on the evening before the surgery. Luckily, my in-laws own a condo within a five minute drive to OHSU. We could even take the streetcar and the aerial tram right from the front door of the condo directly to the hospital. It was not an option for immediately following surgery, but Sweet Pea and I had taken that route during an earlier visit.  

We arose early on November 15 and were at the Elks Children's Eye Clinic by 7:45 am. An orthoptist examined Sweet Pea's eyes and recorded the data regarding her current vision and percent of inward crossing. We proceeded up one flight to the surgery center, where we registered and waited. 

We were all as prepared as we be. I had heard an explanation of the surgery twice already, so we knew the doctor would be cutting through the lining of each eye, secure two of the inner muscles on each eye with sutures, use a scalpel to cut these muscles from their attachment sites, reattach each to a new location using dissolvable sutures, and finally suture the eye linings. We knew that a pediatric anesthesiologist would comfort Sweet Pea and put her to sleep before they did anything else. We knew it might take a while for her to wake up after surgery and that she would likely be confused, upset, maybe even angry when she awoke.

When her name was called, we followed a nurse to the pre-op area where there was a roll-away bed, a cart of medical equipment, a small table, and a glider. This small area was separated from many other similar pre/post-op areas by sliding curtains. Not exactly spacious or private, but efficient I suppose. The nurse took Sweet Pea's vital signs and gave her some liquid medicine containing a sedative. We changed her into some hospital pj's and I sat in the glider with her on my lap. When the anesthesiologist came in, she asked if we thought the sedative was having an effect. Baba responded that he had never seen our daughter sit so still for so long. I was treasuring every cuddling moment as I tried to push away my fears of the worst things that could happen during surgery.      

The anesthesiologist and opthalmologist both took time to thoroughly explain the procedures, answer all our questions, and set us at ease. Sweet Pea has always been very brave about going to the doctor, getting shots, and even having her blood drawn. She exhibited no fear during the entire preoperative proceedings. Finally the dreaded moment came when we set our daughter on the bed, gave her a kiss, and watched as they wheeled her away from us down a hallway to the operating room. That was definitely one of the scariest parent moments either of us have experienced to date. 

There was nothing left to do but walk away and go find something to do for the next 90 minutes. Naturally, my husband suggested food. We made our way from the eye clinic over to the main hospital, where we found a big cafeteria where we ordered whatever we wanted for breakfast and ate it overlooking trees of fall color and the Willamette River. Odd feeling to go about such normal activities when your daughter is undergoing an operation. 

Post-Op: All is fine, but find that sock!

Before long, we were meeting with the surgeon who explained that the surgery went well and Sweet Pea would be waking soon. Her only discovery of note was that our daughter's eye muscle anatomy was slightly unusual. The inner muscles were thinner than normal and the rotator muscle curvature was opposite of normal. She did not express concern about these findings and could not confirm whether or not this contributed to her strabismus.

When it was time to go see our daughter after surgery, all cautionary advice proved to be well warranted. She cried and screamed and wailed, and arched her back when the post-op nurse put her in my arms. I held her as tight as possible, hummed, talked, sang, and mostly just tried not to drop my inconsolable child. The focus of her frustration became the fact that she was missing a sock on her left foot where they had inserted the IV. She cried, "My sock! My sock! I want my sock!" In our confusion, Baba looked around for the missing sock until the nurse pointed out that it was on top of the sock on her right foot. For some reason which made no sense to me, the needle end from the IV was still in her foot. Sweet Pea would have grabbed it and ripped it right off of her foot if we hadn't gotten the nurse to remove it promptly. Baba had to hold her kicking legs and I held her flailing arms and body while the nurse tried to stop the bleeding. Unfortunately, even after the sock business had been resolved, Sweet Pea remained very upset, refusing all attempts at placating her, including a popsicle. Finally, we just carried her out in her hospital pj's crying all the way down the elevator and out to the car.

She fell asleep during the five minute ride back to the condo and proceeded to sleep in bed for the next three or four hours, and most of the night too. She awoke long enough to let us give her some pain medicine and eye drops, to eventually eat some dinner and watch a little movie, then for a couple of hours during the night since she had slept so much of the day.

We returned to see Dr. Reznik the next day, who determined that Sweet Pea was recovering as expected and the crossing, although not eliminated, was reduced from 25-30% to about 5-8% as a result of the surgery. It was not the perfect result I had hoped for, but was a significant improvement. I was glad we had decided to have the surgery done. I am thankful for Dr. Reznik and her team at the Elks Children's Eye Clinic for their professionalism and care. I am glad it is over and look forward to looking into Sweet Pea's beautiful dark eyes and having her look straight back at me.

     

My Daughter's Eyes

My daughter is beautiful. I know you think that I am biased just because I am her mother. While there may be some truth to that, the reality is that she is beautiful. I can claim no magical alignment of genes from my husband and me, as she is adopted. I can only imagine that her Chinese birth parents are both very good looking. I wish they could see their beautiful creation.

She was not a beautiful newborn. Indeed, few newborn babies are. But, now at nearly three years of age, she has grown into a beautiful young girl. She is tall and well-proportioned. She has long dark hair with an auburn hint when the sun shines on it. She has smooth glowing skin. Her lovely round face is accented by the perfect button nose, glossy lips, and dark smiling eyes.

almost 3 years old

Yet beauty is not comprised completely of perfect features. The secret to beauty is in the abnormalities that enhance the perfection and thus create something unique. My daughter is not perfect. She has a scar over her tailbone from the removal of a benign tumor when she was one month old. Her skin is prone to eczema and breaks out in little red bumpy rashes from the heat, the pool, the dry air, you name it. And one of her lovely eyes crosses inward.

I first thought that I noticed something was not quite right with her eyes when we received photos from around eight months of age. It really was barely noticeable and no one else seemed to see it. In the complex mess of paperwork and packing to go to China to meet our daughter, the vague concern about her eyes receded to the back of my mind. In a hotel meeting room in Beijing on the eve of “Gotcha Day,” we were handed a red silk fabric covered notebook with everything the adoption agency considered necessary for us to know before meeting our child. Upon opening the notebook and discovering a packet of new photos of our daughter, the rest of the information was deemed completely irrelevant and quickly ignored. Once again, I noticed her eyes, but thought that I was being paranoid and just searching for any sign of an undisclosed medical issue. I pushed the thought aside and absorbed the beauty of this child who was my daughter and would be in my arms in less than twenty-four hours. And once she was, we spent every moment of the next few months just trying to figure out how to meet her immediate needs. We were new to the whole parenting gig and had a lot to learn.

about 8 months old

11 (almost 12) months old

The first year of parenthood went by like a flash. Our daughter had plenty of doctor appointments during that year, catching up with all the necessary vaccinations and having her blood drawn to test for any signs that the teratoma she was born with would grow back. Thankfully, it did not and her development was right on track. Soon, friends started to comment on her eye. I had noticed it crossing more and more over the course of the year and had resolved that I would ask her pediatrician about it at her next annual appointment. After all, she did not show any signs that she could not see well or that it bothered her. A chance meeting encouraged me to make an earlier appointment with a pediatric opthalmologist.

The opthalmologist’s exams revealed that her left eye was indeed crossing inward, a type of strabismus called esotropia, and that her vision in that eye was weaker than in her right eye. He explained that, for a variety of possible reasons, her brain had selected to primarily use the right eye, especially for near focus, thus causing a “disconnect” between the left eye and the brain, called amblyopia. She was farsighted, not extremely, but more so than the average two year old. He prescribed glasses to correct the farsightedness and physically patching over the right eye a couple of hours daily to force the brain to use the weaker left eye and improve vision in that eye. At the three-month and six-month follow up appointments, the ophthalmologist noted improved vision in her left eye but no improvement in the crossing; although now the right eye was crossing almost as frequently as the left which indicated that the brain was reconnecting with that eye, a positive result from the patching. He discussed the possibility of eye muscle surgery and increased patching to achieve the best possible vision in the left eye beforehand. At the nine-month appointment, surgery was recommended.

A second opinion by another pediatric ophthalmologist at the Elks Children’s Eye Clinic, part of the Casey Eye Clinic at OHSU in Portland, Oregon, confirms the recommendation of eye muscle surgery to correct the crossing. Unfortunately, the type of strabismus my daughter has often requires repeat surgeries over the years. Also unfortunately (and this is the part where I wish I could go back in time and make myself heed my maternal instincts), apparently the brain becomes pretty “hard-wired” to the eyes by the age of two years, so although surgery will correct the crossing of the eyes, it is unlikely to improve her ability to use the eyes together to achieve good depth perception, or binocular vision. The good news is that the brain and eyes adapt to poor depth perception by using other visual and sensory clues; and her beautiful eyes will be straight and should track together more often. Vision tests from this appointment indicate that her vision is actually now better without her glasses and that since both eyes are able to fixate and hold focus on an object equally (but not together), we can back off on the patching to just a couple of days a week. We will miss seeing how cute she is with her glasses, but we will not miss the patching as the adhesive from the patch aggravates her sensitive skin.

I do not like the idea of having my daughter undergo any type of surgery, but I want to do what is right and best for her. I am reassured by the second opinion and by having the surgery done by a surgical team that is dedicated to working just with children. I will update this post in November, pre- and post-surgery.

My daughter is not perfect, but she is perfectly beautiful. I want her to see this too, with her heart and with her eyes.