No more squinting

By modeling the soft tissue biomechanics and the suspension of the human eye Dr. Sander Schutte believes surgery to correct crossed eyes can be improved.

As an engineer Schutte was stunned when he first started studying the eye. The eyeball has no system with pulleys behind it. Yet it turns in almost pure rotation. “The rotation of the eye is achieved by interacting soft tissues only. It’s fascinating”, says the researcher who studied these interacting soft tissues and who defended his thesis ‘The improvement of strabismus surgery, the role of the suspension of the human eye’ last month at the MMME faculty.

The ultimate goal of Schutte’s work is to help improve surgery for patients who are cross eyed. Most of these operations are corrections of horizontal eye position by relocating the insertion of one eye muscle on the eye a few millimeters backwards.

These surgeries could be substantially improved. About twenty per cent of all patients need a reoperation because their strabismus was over- or under corrected. One cause of this error is the fact that the anatomy and physiological properties of the eyeball, the muscles and the orbital fat vary greatly between patients.

To model the way all the tissues act together, Schutte studied dissected eyes and also a functioning eye of a person suffering from Crouzon syndrome who had bulging eyes and went through surgery.

Schutte made CT scans behind the eye to visualize the muscles and orbital fat interacting with one another while the patient was looking in different directions. He also had the rigidity of muscles and the viscosity of the fat analyzed on students with an MRI scanner.

Combined with his finite element model this type of MRI data could help surgeons to much better predict the right muscle insertion location. Unfortunately MRI is still too expensive to perform on all patients before surgery.

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