Strabismus treatment goals vary among patients, age groups, surgeon says

DANA POINT, Calif. — The goals of strabismus treatment differ between adult and child populations, according to a surgeon speaking here. Treatment approaches should focus on either restoring or establishing binocular vision, depending on the patient, she said.

The key to treating children with strabismus is to "establish" binocular function as well as a normal appearance, said Shira L. Robbins, MD, at the Ocular Drug and Surgical Therapy Update meeting.

In adults, however, the key is to "restore" binocular function as well as normal appearance, she said, noting that establishing and/or restoring a normal appearance is an important social goal for both children and adults.

Dr. Robbins underscored this point by referring to a study involving altered photos of the same man with either a normal or a strabismic gaze. Investigators attached these photos to the same resume and sent them to major corporations, and they found that each resume received different responses, she said.

"The strabismic was not offered any interviews, which is not overall surprising," Dr. Robbins said. "I think it is significant with this condition of diplopia, if it is caused by strabismus."

She highlighted binocular diplopia caused by paretic strabismus and restrictive strabismus as particular concerns for ophthalmologists.

"In paretic strabismus, these conditions can kill and blind. If you have a patient who walks into the office with a paretic muscle, these folks need to be neuroimaged," Dr. Robbins said.

When initiating treatment of diplopia in strabismus patients, Dr. Robbins also encouraged surgeons to obtain past medical records for their patients.

"We need to know what came before. Akin to turning a power switch on a television before you try to fix the reception, try the basics," she said. "Do you have rounded prisms? Are there tilted lenses? Is the patient in the right spectacles?"

Treatment options for strabismus-induced binocular diplopia include orthoptics or eye exercises, Botox injections (botulinum toxin type A, Allergan), myotoxic agents, surgery and occlusion as a last-ditch effort, Dr. Robbins said.