Surgeon: Strabismus surgery in adults poses challenges

LAS VEGAS — Treating adult patients with strabismus can be challenging, but there are management options that can help improve vision. The key is remembering that the goals of adult strabismus surgery, and the surgery itself, are different from those in children with strabismus, according to a surgeon speaking here.

"Adults are different than children," said Davis B. Granet, MD. "In kids, we are trying to establish binocular vision; we are trying to establish normal appearance. In adults, we are trying to restore normal appearance. We are trying to restore binocularity. ... And we are trying to expand ... visual field," he said.

Dr. Granet noted that there are several reasons adults delay seeking care for strabismus, "but they all fit into primarily one category: lack of education, either education on the patient's part or the ophthalmologist who told them that change was impossible," he said.

"The general ophthalmologist should never tell the adult strabismus patient that nothing can be done because, almost always, something can be done," Dr. Granet said.

Adult strabismus can arise from numerous causes, including neurologic issues, trauma and systemic disease. Before treating, it is particularly important to understand the patient's history, including medical history, current refractive correction and accommodative ability, he noted.

"Adults have other diseases that it is incumbent upon the ophthalmologist to identify. Those other diseases may be more important than the strabismus that brought them to you in the first place," Dr. Granet said.