Most metropolitan anterior segment surgeons like me rarely see infants younger than 1 year old with congenital esotropia these days because they are usually referred directly from a pediatrician or family physician to a pediatric ophthalmologist. However, we all see many adult patients with strabismus. At our recent Minnesota Eye Consultants “Perspectives in Ophthalmology” meeting, my new associate Mrunalini Parvataneni, MD, delivered a talk I found quite interesting on adult strabismus. I would like to share a few key points.
As much as 4% of the adult population has strabismus, and while in 65% of cases the onset is during childhood, many patients seek treatment by an ophthalmologist later in life. They can be and usually are troubled by many symptoms including diplopia, torticollis, loss of binocularity, abnormal visual fields and visual confusion. Even more important, most show decreased psychosocial functioning and quality of life, and they suffer from reduced job satisfaction and economic success.
These adult patients with strabismus deserve treatment, often surgical, and it can be life changing for them. Regardless of etiology, 82% to 100%, depending on the series reported, have normal ocular alignment restored with a single low-risk low-morbidity muscle procedure. Intractable diplopia, a concern that often reduces the likelihood for an ophthalmologist to recommend surgical correction, occurred in only three of 424 patients (0.8%) undergoing surgery in a series reported by Kushner.
Several studies suggest that the adult patient with cosmetically meaningful strabismus is often not offered surgical treatment, sometimes for decades, despite seeing several ophthalmologists. This delay in treatment results in an unfortunate and quite real negative impact on the quality of life and psychological well-being of the adult with strabismus. So, while I am unlikely to see a 3- to 12-month-old infant with strabismus any time soon, I will see many adults with strabismus, and I plan to help the adult patients I see by encouraging them to see a colleague expert in their treatment and reassuring them that surgical repair of their strabismus works well and is low risk for the adult-age patient.
- Kushner BJ. Arch Ophthalmol. 2002;doi:10.1001/archopht.120.11.1498.
Disclosure: Lindstrom reports no relevant financial disclosures.