Well, it took longer than I intended to get around to making an appointment for Addy with a vision therapist, but we finally took care of it this morning!
Long story short: the doctor did not think therapy would be beneficial to Addy at this point, but she also recommended against another surgery. She thinks we ought to just continue monitoring her vision, and hopefully we can come back for therapy when Addy is a little older.
Bigger picture: The doctor (I'll call her Dr. D) confirmed that Addy's eyes are still turning in a fair amount. She is, however, still seeing 20/20 in both eyes for distance, and at least 20/30 up close. She said she notices that Addy's right eye tends to dominate when she is looking at things far away, but she tends to use the left when she looks up close. That is good news, because it means she is still getting stimulation for both eyes, and we should not need to patch in order to maintain good vision in both eyes (which she said is all the patching would really be good for at this point).
At Addy's age, however, Dr. D said she doesn't think Addy would be able to understand the concepts of what they would be trying to do with the therapy. I don't know a whole lot about therapy methods, but just from what I've heard, and what I've seen about how Addy interacts with the doctors during her exams, that sounds like a fair assessment to me. Addy is a bright little kiddo, but I can see these things being a bit difficult for a 4-year-old to grasp... and she tends to just go along with you and think (or pretend) she is doing things right when she really has no idea what you're talking about. I think Dr. D generally works with older patients anyway, but she said specifically that Addy's case is "too complicated" for it to be a good fit at this time. I forgot to ask when might be a good point at which to try again, but I'm guessing we may try heading back that direction in another couple of years.
In the meantime, though, Dr. D said she thought a third surgery would not be a good idea. (I was very encouraged to hear my instincts receive some confirmation there!!) I've watched the doctors measure Addy's alignment, and they always have trouble getting her to focus, so I could see how their measurements could easily be a bit off. Dr. D worked with Addy more patiently than most doctors or nurses I've seen who evaluated her before (which I greatly appreciated!) but even she was having trouble getting an accurate measurement. And after all, the surgeons are adjusting the eyes based on their measurements, so if these are a bit off, the surgical results will be a bit off as well. Dr. D also mentioned that further surgeries can become more complicated because of the scar tissue that is added with each surgery... I'm not exactly sure what she meant there, but it seems to make sense.
Since Addy's regular eye doctor / surgeon has moved away anyway, Dr. D recommended another eye doctor to us, who is not a surgeon. She said that she thinks sometimes a doctor who is also a surgeon will tend to recommend surgery more quickly than a non-surgeon, which makes a lot of sense. (This has always been a bit of a reservation of mine about Addy's regular doctor, actually, though I don't know that I completely realized why.) So, we may be checking in with this other doctor sometime soon... We still do need to make sure Addy is at least using both eyes and maintaining good vision in each eye, even if they are not really working together.
Addy seems to be seeing and functioning fine overall... She does seem maybe a little slow on fine motor skills, but with time and a little extra effort, I think we can work on that. I'm thankful she is doing so well in spite of all the physical challenges she's had!
As far as prayer requests, we would appreciate prayer that Addy's eyes at least don't get any worse as we wait til a more appropriate time to approach therapy. (If God chose to work a miracle and heal her in the meantime, though, that would of course be AWESOME!!) Prayers for wisdom on where and how and when to approach further challenges would be appreciated as well.
As always, thank you for keeping up and praying with us!!