Strabismus surgery on the elderly and the effects on disability

The impact of strabismus on psychosocial heath and quality of life: a systematic review

Strabismus can hinder an individual's ability to perform daily functions and negatively affect their well-being. I examine the impact strabismus has on psychosocial health and quality of life in children and adults and evaluate the challenges confronted by parents of children with strabismus. Numerous misconceptions exist regarding the impact strabismus has on overall health. Negative attitudes persist toward those affected, resulting in difficulties with self-image. Individuals with strabismus are at increased risk for both visual system and psychiatric disorders. Misinformation regarding available treatment options for children and adults with strabismus continues to exist, resulting in decreased access to care. Improved education of health care providers can increase appropriate referrals and initiation of treatment. Treatment of strabismus is not merely cosmetic and has the potential to improve psychosocial health and quality of life for children and adults with and without diplopia.

Psychosocial impacts of adult strabismus and strabismus surgery: a review of the literature

BACKGROUND

Patients with strabismus may suffer from both reduced visual functioning and the psychosocial effects of ocular misalignment. For adults with strabismus, there is a strong body of evidence supporting the advantages of surgical restoration of binocular visual function. However, even in the absence of binocular visual potential, patients may benefit from reconstructive surgery to restore an aesthetically acceptable ocular alignment.

OBJECTIVE

To review the psychosocial implications of strabismus in the adult population and to summarize the psychosocial impact of surgical correction.

METHODS

A Medline search (1946-2013) was conducted to identify the psychosocial implications of strabismus, its effects on employment, and the impact of surgical correction on strabismic adults using the following keywords: strabismus, surgery, quality of life, life style, employment/employability effects, job satisfaction, social support/social isolation/social marginalization, adaptation, stress, depression, family relations, interpersonal relations, friends, and peer group. The search was limited to patients older than 18 years and studies published in English. Of the initial 87 articles for which abstracts were reviewed, 20 studies were of sufficient relevance to be included in the review.

RESULTS

Eight studies examined the psychosocial impact of strabismus, 2 of which explored the effect of strabismus on finding partners, and 4 studies examined the effect of strabismus on employment. These studies examined perceptions of both patients with strabismus and the general population. Eight studies evaluated the impact of strabismus surgery. Strabismus was shown to have negative psychosocial functioning and employability in both patients' and the public's perceptions. Surgical correction was associated with long-lasting improvement in psychological and social functioning.

CONCLUSIONS

There is a fairly strong body of evidence in the literature to suggest that adult strabismus patients suffer significant social, psychological, and economic effects because of their condition. Surgery can be effective in improving these disadvantages. Clinicians should be aware of the importance of offering surgery to patients with significant strabismus, even in patients for whom it is not expected to improve visual function.

Driving Skills Tested on Simulator After Strabismus Surgery: A Prospective Study

Purpose

The sense of vision is responsible for 90% of the information obtained by the motorist. Improvement in binocular visual acuity (VA) and visual field (VF) achieved after strabismus surgery could have beneficial effects on driving. Our study sought to identify functional improvements (VA and VF) and improvements in driving ability following strabismus surgery.

Methods

In a prospective cohort study, the following parameters are analyzed before and 3 months after strabismus surgery: simulated driving performance (including eye movements and actions on vehicle control), binocular VA, binocular VF, and self-confidence during driving.

Results

Twenty patients participated in the study. The mean preoperative logMAR binocular VA and stereopsis do not significantly differ from the postoperative. The mean Esterman VF score increases from 91.3 (±17.2) preoperatively to 96.9 (±13.9) postoperatively (P = 0.045). The mean self-confidence directed at driving scores decreases from 20.5 (±10.3) points before surgery to 11.0 (±6.0) points after surgery (P < 0.001). The distance at which the road signs are identified is significantly higher after surgery. The average speed of the vehicle and the speed near the targets (30 m) increase significantly after strabismus surgery. A significant decrease in ocular movements near targets is also observed. The number of brake pedal depressions and the rate of brake pedal depressions slightly decrease after surgery.

Conclusions

This study demonstrates the potential beneficial effects of strabismus surgery on driving ability, with significant improvements in self-confidence during driving, VF, and driving on a simulator.

Translational Relevance

This was the first study to use a driving simulator in strabismus.

Intelligent Evaluation of Strabismus in Videos Based on an Automated Cover Test

Strabismus is a common vision disease that brings about unpleasant influence on vision, as well as life quality. A timely diagnosis is crucial for the proper treatment of strabismus. In contrast to manual evaluation, well-designed automatic evaluation can significantly improve the objectivity, reliability, and efficiency of strabismus diagnosis. In this study, we have proposed an innovative intelligent evaluation system of strabismus in digital videos, based on the cover test. In particular, the video is recorded using an infrared camera, while the subject performs automated cover tests. The video is then fed into the proposed algorithm that consists of six stages: (1) eye region extraction, (2) iris boundary detection, (3) key frame detection, (4) pupil localization, (5) deviation calculation, and (6) evaluation of strabismus. A database containing cover test data of both strabismic subjects and normal subjects was established for experiments. Experimental results demonstrate that the deviation of strabismus can be well-evaluated by our proposed method. The accuracy was over 91%, in the horizontal direction, with an error of 8 diopters; and it was over 86% in the vertical direction, with an error of 4 diopters.

Strabismus in Adults Older Than 60 Years

PURPOSE

To describe the epidemiology of adult strabismus, its etiology, and treatment methods in patients 60 years and older presenting to a tertiary care center.

METHODS

This retrospective chart review study of patients with strabismus was performed at the Ratner Eye Center, University of California-San Diego. Data collected included demographics, etiology of misalignment, alignment in the primary position, binocularity, previous surgical intervention, and treatment methods.

RESULTS

A total of 291 patients were included. The majority of patients (87.9%) had an acquired underlying etiology of misalignment (neurological, non-neurological, thyroid eye disease, or myotoxic). The most common presenting complaint was diplopia (77%). A total of 38.8% of patients had previous strabismus surgery. Surgical interventions were pursued in 32% of patients.

CONCLUSIONS

This article provides insight into the epidemiology of strabismus in patients older than 60 years. The characterization and greater understanding of strabismus in this age group can be used to enhance prevention, diagnosis, and treatment of these patients. [J Pediatr Ophthalmol Strabismus. 2016;53(6):365-368.].

A survey of outcome of adjustable suture as first operation in patients with strabismus

Background:

Adjustable suture used for years to improve the outcome of strabismus surgery. We surveyed outcome of our patients with strabismus who underwent adjustable suture.

Materials and Methods:

This retrospective study was performed at Ophthalmology Centre of Feiz Hospital in Isfahan on 95 participants that candidate for adjustable suture strabismus surgery. Patients were divided into three age groups: Under 10 years, 10-19 years, and 20 years and over. Outcome of adjustable suture surgery consequence of residual postoperative deviation was divided into four groups: Excellent, good, acceptable, and unacceptable.

Results:

Out of 95 patients studied, 51 (53.7%) were males and 44 (46.3%) were females. The mean of deviation angles were 53.8 ± 17.9 PD (Prism dioptres) in alt XT, 44.5 ± 12 PD in alt ET and 52 ± 13.5 PD in const ET, 47.1 ± 13.1PD in cons XT, respectively. There was no significant difference between the groups (P = 0.051). Results of surgery were in 38 patients (40%) excellent, in 31 patients (32.6%) good, in 19 patients (20%) acceptable, and in 7 patients (7.4%) unacceptable. Seven (7.4%) patients required reoperation.

Conclusions:

In the present study, the frequency of re-operation was much lower than other similar studies (7.4% vs. 30-50%). This suggests that the adjustable technique that used in our study can be associated with lower reoperation than other adjustable techniques used in the other similar studies.

Improved ocular alignment with adjustable sutures in adults undergoing strabismus surgery

OBJECTIVE

To assess whether outcomes of strabismus surgery are improved by using the adjustable suture technique and to determine which subgroups of strabismus patients benefit most from the adjustable suture technique.

DESIGN

A retrospective chart review.

PARTICIPANTS

A total of 535 adults who underwent strabismus surgery between 1989 and 2010.

METHODS

Success was defined as ≤10 prism diopters (PD) for horizontal deviations and ≤2 PD for vertical deviations. Differences in the proportion of successful strabismus surgery were analyzed using a chi-square test with an alpha of 0.05.

MAIN OUTCOME MEASURES

Ocular alignment in primary position at a 7-day to 12-week follow-up examination.

RESULTS

A total of 491 patients met the inclusion criteria (nonadjustable suture, n = 186; adjustable suture, n = 305). The success rates for the nonadjustable and adjustable groups were 61.3% and 74.8%, respectively (χ(2)=9.91, P=0.0016). Adjustable suture use was particularly beneficial for patients undergoing a reoperation for childhood strabismus (success rate: nonadjustable, 42.4%; adjustable, 65.7%; P=0.0268; n = 100). The differences in outcomes were not statistically significant for patients with childhood strabismus undergoing a primary surgery (nonadjustable, 65.0%; adjustable, 81.4%; P=0.1354; n = 90) or with thyroid orbitopathy (nonadjustable, 76.7%; adjustable, 74.1%; P=0.8204; n = 57).

CONCLUSIONS

Strabismus surgery using adjustable sutures was associated with improved short-term ocular alignment compared with strabismus surgery without the use of adjustable sutures. Adjustable sutures were most beneficial for patients undergoing reoperations for childhood strabismus.