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
-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
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.
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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.