Adult Strabismus


Strabismus is a misalignment of the eyes.  The condition occurs in 4% of the population for both children and adults.  There are various types of strabismus such as inward or outward turning, or even vertical and torsional deviations.

In adults, strabismus generally results from progressive, unsuccessfully treated childhood strabismus, or untreated childhood strabismus.  Adults may develop strabismus following an injury or due to certain diseases.  Often, adults complain of double vision when strabismus initially develops or worsens.

Historically, many people, and some physicians, believed strabismus could not be corrected in adults or that is was only "cosmetic".  However, strabismus surgery is reconstructive and can restore or improve overall alignment of the misaligned eyes.  Multiple studies have demonstrated the various benefits of realigning adults with strabismus.  Advances in surgical management of strabismus now provide benefits for adults.  Potential benefits of strabismus surgery in adults include improved binocular movement, increased binocular field of vision, and improved depth perception.  Additionally, patients often state they have an improved sense of self-esteem, job advancement, reading tasks, or driving.  On occasion, vision in the misaligned eye has even improved though this is less common.

Strabismus in adults can be treated with glasses, occlusion, prisms, chemical denervation, chemical augmentation, and surgery.

2012 Joint Policy Statement from AAPOS and AAO Regarding Medical Necessity of Adult Strabismus Surgery

-from the Academy of Pediatric and Ophthalmology and Strabismus

and

-from the American Academy of Ophthalmology

Strabismus is a misalignment of the eyes. It is not a normal condition. Strabismus surgery is the only effective treatment in many of these patients. Surgical correction or strabismus in adults is reconstructive in nature and not cosmetic. The indications for strabismus surgery are:

(1) Elimination of double vision (diplopia)
(2) Improvement of three-dimensional vision
(3) Expansion of visual field
(4) Elimination of abnormal head posture
(5) Improvement of psychosocial function
(6) Improvement of vocational status

 

2012 Policy Statement on Adult Strabismus

 

Corrective surgery is a medical necessity and its correction should be a covered benefit by insurance companies, health plans and third party payers. However, the issue of insurance coverage is controlled by individual insurance policies. Patients should therefore verify coverage with their insurer.

Sources:

1. Mets MB, Beauchamp C, Haldi BA. Binocularity following surgical correction of strabismus in adults. Trans Am Ophthalmol Soc 2003; 101: 201-8.

2. Burke JP, Leach CM, Davis H. Psychosocial implications of strabismus surgery in adults. J Pediatr Ophthalmol Strabismus 1997; 34:159-64.

3. Satterfield D, Keltner JL, Morrison, TL: Psychosocial aspects of strabismus study. Arch Ophthalmol 1993; 111:1100-5.

4. Lipton EL. A study of the psychological effects of strabismus. Psychoanal Study Child 1970; 25: 146-74.

5. Olitsky SE, Sudesh S, Graziano A, Hamblen J, Brooks SE, Shaha SH. The negative psychosocial impact of strabismus in adults. J AAPOS 1999; 3:209-11.

6. Coats DK, Paysse EA, Towler AJ, Dipboye RL. Impact of large angle horizontal strabismus on ability to obtain employment. Ophthalmology 2000;107:367-9.

7. Wortham ED, Greenwald MJ. Expanded binocular peripheral visual fields following surgery for esotropia. J Pediatr Ophthalmol Strabismus 1989; 26: 109-12.

8. Kushner BJ, Morton GV. Post-operative binocularity in adults with long-standing strabismus. Ophthalmology 1992; 99:316-9.

9. Ball A, Drummond GT, Pearce WG. Unexpected stereoacuity following surgical correction of long-standing horizontal strabismus. Can J Ophthalmol 1993; 28: 217-20.

10. Morris RJ, Scott WE, Dickey CF. Fusion after surgical alignment of longstanding strabismus in adults. Ophthalmology 1993; 100:135-8.

11. Kushner BJ. Binocular field expansion in adults after surgery for esotropia. Arch Ophthalmol 1994; 112:639-43.

12. Lal G, Holmes JM. Postoperative stereoacuity following realignment for chronic acquired strabismus in adults. J AAPOS 2002; 6; 233-7.

13. Scott WE, Kutschke PJ, Lee WR. Adult strabismus. J Pediatr Ophthalmol Strabismus 1995; 32: 348-52.

14. Hertle RW. Clinical characteristics of surgically treated adult strabismus. J Pediatr Ophthalmol Strabismus 1998; 35: 138-45.

15. Beauchamp GR, Black BC, Coats DK, Enzenauer RW, Hutchinson AK, Saunders RA, Simon JW, Stager DR, Stager DR Jr, Wilson ME, Zobal-Ratner J, Felius J. The management of strabismus in adults. I. Clinical characteristics and treatment. J AAPOS 2003; 7: 233-40.

16. Johnson CA and Keltner, JL. Incidence of visual field loss in 20,000 eyes and its relationship to driving performance. Arch Ophthalmol 1983; 101: 371-5.

17. Keltner JL. Strabismus surgery in adults. Functional and psychosocial implications. Arch Ophthalmol 1994 112:599-600.

 

The impact of strabismus surgery for any ocular misalignment may take several weeks to manifest and may not be present in the immediate postoperative period.  Strabismus surgery may result in overcorrection or undercorrection and may require further surgery in the future.