Does Strabismus Surgery Improve Quality of Life?

And the answer is of course, it depends!

But … depends on what?  After all, it has been reported that nearly half of adult patients  who undergo strabismus surgery do not feel that the outcome has improved their QoL, or Quality of Life.  (Hatt SR, Leske DA, Liebermann L, Holmes JM. Comparing outcome criteria performance in adult strabismus surgery. Ophthalmology 2012; 119: 1930-1936.)

A couple of years ago we blogged about the work of McBain and colleagues at City University London regarding the psychosocial factors in strabismus.  Now the same group has extended their work with a new publication in the journal Eye titled:  Does Strabismus Surgery Improve Quality and Mood, and What Factors Influence This?  

Here is a key comment from the discussion section of their paper:

“Surgery deemed partially successful was found to be more psychologically detrimental, leading to a reduction in psychosocial quality of life from pre- to post surgery.”

There are several ways to look at the results, primarily reported in the tables of the paper that frankly aren’t easy to decipher.  One is that the clinical outcomes themselves don’t relate to the patient’s perception of improvement in QoL.  The limitation to this conclusion is that the data does not include any sensory measures other than the report of diplopia.  But even if one considers the change in cosmetic alignment before and after surgery, it would be understandable that patients with high expectations prior to surgery might be disappointed with the post-surgical results.  Further there are adults who have the perception of their eyes not working together that still plagues them after surgery, and they often feel that others can sense this residual abnormality.

It still mystifies me why strabismus surgeons don’t collaborate more often with optometrists on pre-surgical factors that might optimize post-surgical outcomes.