Connecting More Dots In Strabismus

yes-noIs strabismus surgery a cosmetic procedure?  The simple answer, believe it or not, can be yes, no, or maybe.  Let’s begin by connecting more of the dots that we put down on paper in our previous blog regarding strabismus as a head-to-toe problem.  It has become clear over the past few years that the deficits involved in strabismus extend well beyond misaligned eyes, evident by scrolling through the many blog posts in which we’ve addressed these issues.  Is it reasonable to consider strabismus surgery as more than a cosmetic procedure?

Burton Kushner is a pediatric ophthalmologist in Wisconsin who has written a great deal on this subject.  In particular he has addressed the topic regarding adults, who have the disposable income and life perspective on making an elective decision about undergoing strabismus surgery.  What prompts us to think about this more is Dr. Kushner’s article in the May issue of Optometry and Vision Science regarding the benefits, risks, and efficacy of strabismus surgery in adults.

In his article Dr. Kushner reviews the potential benefits of strabismus surgery which includes improved stereopsis, expansion of the binocular visual field, and improved psychosocial implications.  Added to the list of benefits might be other functional deficits noted in strabismus.  To his credit, Dr. Kushner notes the applicability of vision training in this equation.  Although not elaborated in his article, the answer to the questions we’ve posed has direct bearing on whether or not medical insurance carriers elect to reimburse for strabismus surgery in adulthood.  If it is essentially a cosmetic procedure, it might be more in the realm of refractive surgery.  On the other hand carriers might begin to request documentation of pre and post functional changes.

Consider for example ptosis surgery.  Certainly adults with droopy eyelids can experience psychosocial issues, with others making value judgements about their appearance and even cognitive state of mind in general, or level of arousal or attentiveness during conversation in particular.  But in order for ptosis surgery to be reimbursed in adulthood, carriers generally require evidence via pre and post surgical visual fields that a visual impairment of sorts has been lessened.  This does not obviate non-surgical approaches such as a ptosis-crutch, and the decision to reimburse is therefore made on a case-by-case basis.

In any event, the article by Dr. Kushner is noteworthy and has deep implications both for a broader view of strabismus treatment in adulthood, and for further considerations in the potential synergy between surgical and nonsurgical approaches.



One thought on “Connecting More Dots In Strabismus

  1. Reblogged this on Wide-eyed Wonder: an artist's musings on three-dimensional vision and commented:
    I just introduced myself as strabismic to a perfect stranger on Wednesday. As Greg fetched an end table in the store for me, and offered an additional discount for the floor model, I noticed a strong turn-in on his right eye. I told him I was also strabismic and asked if he alternates use of his eyes. Both eyes lit up and he cheerfully reported “No— I can barely see out of this eye.”

    He said it never used to bother him, but lately he was considering surgery if he could even get enough money together. I told him to hold off and consider vision therapy and gave him my blog address where he can connect to Strabby, who has improved her vision in her lazy eye.

    Added bonus: this week’s article by Dr. Press about creating more synergy with vision therapy before and after possible strabismus surgery!

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