Using Creativity to Address Eye Misalignment

Edward Kuwera and Laura Newman

Edward Kuwera and Laura Newman

Published in Wilmer - Annual Report 2024

Laura Newman began having difficulty with the vision in her left eye after undergoing a craniotomy to remove a brain tumor at The Johns Hopkins Hospital in February 2023. The tumor had grown around Newman’s left abducens nerve — a cranial nerve responsible for horizonal eye movement — which had to be severed to remove the tumor. Newman awoke from surgery with double vision as a result of her left eye now crossing toward her nose. “You take for granted being able to use two eyes to see everything. It was really upsetting to have one eye with basically the vision taken away,” says Newman, who began patching her left eye in her work as a research associate in Fort Detrick, Maryland.

Newman’s neurosurgeon, Rafael Tamargo, M.D., referred her to Edward Kuwera, M.D., who specializes in pediatric ophthalmology and adult strabismus, or eye misalignment, at the Wilmer Eye Institute, and Kofi Boahene, M.D., an otolaryngologist and facial plastic surgeon at Johns Hopkins.

Kuwera performed two surgeries to improve Newman’s alignment and double vision, while Boahene executed several procedures, including stitching Newman’s bottom left eyelid to address severe ocular dryness, another complication from the craniotomy. Throughout, Kuwera and Boahene communicated about each other’s upcoming surgeries and plans of care for Newman.

“It’s very challenging to restore some kind of alignment in the eye when you have complete loss of a muscle,” says Kuwera, referring to the lateral rectus muscle lost with the severed nerve. “I told Ms. Newman we could uncross her eye to give her something close to single vision — but I didn’t know how close to perfect we would get.”

Newman had her first surgery in August 2023. During the procedure, Kuwera moved the superior and inferior rectus muscles, located on the top and bottom of the eye, respectively, to the left side of her eye, straddling the damaged lateral rectus muscle. This greatly improved the crossing of her left eye and brought the double images she was seeing closer together. But Newman’s left eye sat slightly higher than her right eye. “We needed to bring the eye down without losing any of the progress we made with the crossing,” Kuwera says. “It’s this art and balance of giving her as much alignment as possible without hurting the other directions of eye movement.”

Kuwera came up with a creative solution. During Newman’s second surgery, in April 2024, he split the inferior rectus muscle, moving half of it back to the bottom of the eye, its original location, while the other half remained on the left side of the eye. This helped pull down Newman’s left eye without affecting the horizontal alignment.

After this surgery, Newman says, “My eye was lined up with the other eye, which is amazing.” In addition, if she turned her head a certain way, she could see a single picture for the first time in more than a year.

Newman has since begun wearing prism glasses, which are designed to correct double vision. She has already seen significant improvement in her eyesight after only wearing the glasses for a few days. “I love my prism glasses. My vision with them is a crystal clear, single image,” says Newman, who will continue to see Kuwera.

“When you’re worried about your vision, having someone like Dr. Kuwera to reassure you is also a positive,” she says. “I only have good things to say about him and the care at Wilmer and Johns Hopkins.”