OUTDATED TREATEMENT: COMPENSATORY PRISMS
# 棱镜补偿
Prisms are special lenses that bend light in a particular way, and can be incorporated into the glasses along with the regular prescription. Many ophthalmologists, and some classical optometrists, use prisms in a compensatory way to treat strabismus. Prisms can be very helpful, especially in cases of strabismus that occur after a brain injury.
棱镜是一种特殊镜片，能够按照特定方向折射光线，可以与常规眼镜处方结合使用。很多眼科医生，还有一些眼视光医生，使用棱镜矫正来治疗斜视。棱镜非常有用，尤其是对脑损伤引发的斜视。
However, except in a few specific cases, I prefer not to use them because they do not teach the patient to move the eyes correctly and do not solve the underlying visual problem. In addition, some patients “eat” the prism resulting in the need for stronger and stronger prisms each year to achieve the same results.
然而，除非一些特殊情况，我一般不使用棱镜，因为，棱镜既不能教会患者双眼协同工作，也无法解决深层次的视觉问题。而且，有些患者就像是在“吃”棱镜一样，每年都要更换度数更高的棱镜，才能维持之前的效果。
OUTDATED TRATEMENT: BOTLINUM TOXIN (BOTOX)
# 肉毒杆菌
Botox is a neurotoxin that has many medical uses. Many know this drug through its widespread cosmetic use as an anti-wrinkle treatment. More recently, botulinum toxin has been used in the treatment of strabismus. When injected into the eye muscles, it weakens or paralyzes them，making the eyes look straighter.
肉毒杆菌是一种神经毒素，具有很多医学用途。很多人知道，这种药物广泛用于美容除皱。最近，肉毒杆菌也被用于治疗斜视。将它注射到眼外肌后，能削弱或麻痹这些肌肉，从而使眼位变正。
As with many other older traditional treatments, it works only on the eye muscles and not on the underlying neurological problem: the brain's control of the eye muscles. It is important to stress once again that for 95% of patients, the problem with strabismus originates in our brain, and not in the eye muscles. Botox is not a good alternative to surgery, and is definitely not a good alternative to optometric vision therapy.
和其它传统治疗方法一样，肉毒杆菌只对眼外肌起作用，而非大脑神经。这里要再次强调，95%的斜视患者，问题出在大脑，而不是眼外肌。肉毒杆菌既不能代替手术，也不能代替视觉训练。
What's more, a 2012 literature review by Rowe and Noonan found many instances of poor response to Botox in patients with strabismus. Botulinum toxin is a powerful drug with potential serious side effects, so that its use, especially in children, should not be taken lightly.
此外，罗威和努南在2012年，发表文献综述指出：很多斜视患者，使用肉毒杆菌效果并不好。肉毒杆菌药效强烈，存在严重副作用，尤其是用在儿童身上时，需要十分谨慎。
•Botox is not a cure, but only a temporary treatment which lasts for 3-6 months, so it must be injected into the eye muscles and then re-injected time and time again.
•The correct dosage can vary widely, and it is difficult to know the correct amount before the injection. The drug may even cause the strabismus to worsen rather than improve.
•The child can be left with a ptosis(droopy eyelid) which is very detracting cosmetically. The droopy eyelid also acts like a patch, blocking vision in the eye.
•The manufacturers of Botox list many potential serious side-effects including diplopia(double vision), blepharospasm (abnormal twitching of the eyelid), torticollis (abnormal position of the head or neck), or ptosis (droopy upper eyelid). Seventeen percent of extraocular muscles adjacent to the injection site have been affected, causing vertical deviations. Retrobulbar hemorrhage (Bleeding behind the eye) even occurs in 0.3% of cases.
•肉毒杆菌无法治愈斜视，效果只能维持3-6个月。所以，需要对眼外肌多次注射。
•肉毒杆菌有效剂量范围很大，注射前很难确定正确剂量，剂量错误可能会加重斜视。
•可能会导致儿童上睑下垂（上眼皮垂下来），严重影响美观。上睑下垂就像眼罩一样，会阻碍眼睛视线。
•肉毒杆菌生产厂家，列举了该药物多种严重副作用，包括复视（重影）、眼睑痉挛（眨眼异常）、斜颈（颈部和头部位置异常）、上睑下垂（上眼皮垂下来）。另外，有17%概率，影响注射点毗邻眼外肌，导致垂直性斜视。有0.3%概率，引发球后出血（眼球后方出血）。
On February 8, 2008, the American Food and Drug Administration (FDA) announced Botox has, “been linked in some cases to adverse reactions, including respiratory failure and death… due to its ability to spread to areas distant from the site of the injection… causing symptoms similar to those of botulism.”
在2008年2月8日，美国国家食品药品监督管理局宣布：“在某些情况下，肉毒杆菌可引发严重副作用，包括呼吸衰竭和死亡……由于该药物能从注射部位，扩散到身体其它部位……引起和肉毒杆菌中毒相同的症状。”
In January 2009, the Canadian government warned that Botox can have the adverse effect of spreading to other parts of the body, which could cause muscle weakness, swallowing difficulties, pneumonia, speech disorders, and breathing problems.
2009年1月，加拿大政府警告：通过扩散到身体其它部位，肉毒杆菌可能引发严重副作用，包括肌无力、吞咽困难、肺炎、以及呼吸障碍。
In September 2005, a study by Cote et al. published in the Journal of American Academy of Dermatology reported that the use of Botox had resulted in 28 deaths between 1989 and 2003, though none were attributed to cosmetic use.
根据2005年9月，科特等人发表在美国皮肤病学会期刊上的研究报告，在1989年到2003年之间，肉毒杆菌共导致28人死亡，但没有任何一例与美容有关。
Parents need to very carefully consider all of the possible adverse side-effects of the injection of botulinum toxin into their children’s eye muscles before agreeing to this treatment. It is a very aggressive and possibly dangerous treatment when compared with other treatment options such as optometric vision therapy. In my opinion, the use of botulinum toxin to treat strabismus is definitely not the most logical, nor the safest treatment choice when so many easier, less invasive, and safer treatment options are available.
家长在同意使用肉毒杆菌，为孩子治疗斜视前，应当认真思考，该药物存在的所有严重副作用。与其它治疗方法相比，比如视觉训练，肉毒杆菌非常激进，甚至危险。在我看来，既然存在很多更简单、更安全的治疗方法，那么，选择肉毒杆菌肯定不符合逻辑。
Botox (Botulinum toxin) is a strong, and potentially
dangerous drug which can have many negative side effects.
肉毒杆菌药效极强，存在大量潜在风险。
（文章摘自: CROSSED & LAZY EYES MYTHS,MISCONCEPTIONS AND TRUTHS）
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