Knapp Lecture
Is strabismus the only problem? Psychological issues surrounding strabismus surgery

Presented as the Philip Knapp Lecture at the 40th Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, Palm Springs, California, April 2-6, 2014.
https://doi.org/10.1016/j.jaapos.2016.07.221Get rights and content

Background

Strabismus, which has been estimated to occur in 4% of the adult population, can have a negative psychosocial effect on an individual's quality of life. While correction of strabismus may improve quality of life, this is not always the case, even if realignment surgery is clinically successful. Surgeons need to understand patients' expectations of postsurgical outcomes and the impact surgery has on their psychosocial well-being.

Methods

This was a prospective cross-sectional study of 220 adult patients undergoing strabismus surgery at Moorfields Eye Hospital NHS Foundation Trust. Clinical assessments were performed before surgery and again 2 weeks and 3 months after surgery. Standardized psychological questionnaires were completed preoperatively and 3 and 6 months postoperatively.

Results

Of 220 patients included in the study (mean age, 45 years), 54% were female, 81% were white, and 58.6% had a concomitant deviation. Prior to surgery, 24% of study participants were experiencing clinical levels of anxiety; 11% were suffering clinical levels of depression. Quality of life improved and anxiety and depression were reduced after surgery. Approximately 6% of the sample regretted having undergone surgery either at 3 or 6 months after treatment.

Conclusions

It is important to identify patients who are experiencing significant psychosocial distress and to assess their postsurgical expectations in order to improve the outcomes of strabismus surgery. Presurgical psychosocial support should be considered for these patients.

Section snippets

Methods

This was a prospective cross-sectional study approved by the North London Research Ethics Committee. All consecutive adult strabismus patients ≥17 years of age listed for strabismus surgery between November 2010 and April 2012 under the care of 2 consultant strabismologists were invited to participate in the study. All questionnaires were completed prior to surgery, after receipt of the standardized information about the surgery from their consultant ophthalmologist. Exclusion criteria were as

Results

A total of 354 patients were approached, of whom 335 (95%) consented to join the study. Baseline data was available for 220 patients, and of these, 210 completed a follow-up questionnaire at 3 months (n = 41), 6 months (n = 25), or both (n = 144). Table 2 provides baseline details.

At baseline, 11% of patients were experiencing clinical levels of depression and 24% were experiencing clinical anxiety, which is approximately 10 times greater than that of the general population25 and in line with

Discussion

Our data suggest that it is not clinical factors that predict psychosocial well-being after strabismus surgery but rather the patient's beliefs and thoughts. Strabismus surgeons must therefore be aware that psychosocial factors are important to acknowledge and vital to ensuring successfully surgical outcomes. It is how the patients perceive their strabismus and not the size of the angle that matters. Surgeons should be aware of the high expectations particularly in younger female patients

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      In addition, these findings apply to individuals with strabismus ranging in age from 65 to greater than 85 years despite the fact that strabismus surgery does not decrease the risk of musculoskeletal injuries, fractures, or falls in this population [38,100,133]. Strabismic individuals experiencing significant psychosocial distress, particularly those without diplopia, tend to be less satisfied following successful surgical intervention [1,10,137]. As a result, it is important for ophthalmologists specializing in strabismus to appropriately educate these individuals before surgery regarding postsurgical expectations, and presurgical psychosocial support should be considered [1,10].

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    Research supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.

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