Adult Strabismus Research Articles

Psychological and functional outcomes of horizontal squint surgery in adults with no preoperative diplopia using Quality-of-Life AS-20 questionnaire

BackgroundCorrective squint surgery has a significant psychological impact, affecting both the quality of life and mental health of patients. This study highlights the quantitative and subjective assessment of both the...

Successful treatment of diplopia using prism correction combined with vision therapy/orthoptics improves health-related quality of life.

To track improvement in diplopia symptoms with strabismus-specific health-related quality of life (HRQOL) questionnaire across a treatment consisting of prism correction followed by vision therapy/orthoptics when prism treatment alone has not succeeded. Forty-eight participants with diplopia and a mean age of 62.45 were asked to complete an Adult Strabismus-20 (AS-20) questionnaire and a Diplopia Questionnaire (DQ) before and after prism correction. Inclusion criteria were diplopia reported on the DQ as "sometimes", "often" or "always" at reading or straight-ahead distance. The prism correction was classified as successful if the participant reported "never" or "rarely" on the DQ for reading and straight-ahead distance; and unsuccessful if the perceived diplopia worsened or remained the same. For all participants, mean initial AS-20 scores were compared with mean post-prism correction scores, taking into account AS-20 subscales (reading and general functions, and self-perception and interaction). Participants in the failed prism treatment subgroup subsequently underwent a programme of vision therapy wearing their prism correction, the results of which were again determined by participants' responses on the AS-20 questionnaire, completed before and after the vision therapy. Five of the 48 participants dropped out of the study. Prism correction was classified as successful in 22 of 43 participants (51%), and unsuccessful in 21 (49%). Those participants for whom the prism correction was classified as a success showed a statistically significant improvement (p = 0.01) in both reading and general functions. In the failed treatment subgroup, no significant change in AS-20 score was recorded for any of the domains (p = 0.1). After treatment with vision therapy/orthoptics, however, 13 of the 20 participants in the unsuccessful prism correction subgroup (one of them dropped out the study) achieved binocular vision and statistically significant improvement in reading and general functions (p = 0.01). Although effective prism correction of diplopia is correlated with enhanced HRQOL, prism correction alone is frequently not sufficient to achieve this objective. In these cases, vision therapy/orthoptics treatment as a coadjutant to prism correction is shown to improve HRQOL.

SUCESSFULL MANAGEMENT OF CHILDHOOD BASIC-TYPE ESOTROPIA IN ADULT PATIENT

Introduction : Strabismus in adults may indicate other pathological causes, such as neurological disorders or trauma. Diagnosis of esotropia in adult patients has to be made carefully to determine the right treatment. Management’s goal of strabismus in adult patients is mainly cosmetic by diminishing deviation.
 Case Illustration : A 46-year-old woman, complaint of inward deviation of both eyes since childhood. There were no complaints of double vision, headaches, nor trauma history. Visual acuity of right eye was 0.4 with BCVA and left eye was 0.8 with BCVA 0.8. Hirschberg test was 45o (Figure 2A). Prism cover test was 75 PD base out in near and distance. Patient was diagnosed with basic-type esotropia. The patient already given spectacles but the deviation persisted so she underwent bilateral medial rectus recess surgery (Figure 2B). Ocular alignment without spectacles 1 week after surgery showed orthotropia and small esophoria. (Figure 2C).
 Discussion : Each esotropia types has a different treatment approach. Basic-type esotropia with large deviation usually needs surgical treatment. Management of childhood onset strabismus in adult patients is challenging because those patients have lesser ability to maintain fusion. Older patients and large deviation are poor prognostic factors to achieve good functional and cosmetics outcome after strabismus surgery.
 Conclusion : Establishing a definite diagnosis in adult strabismus patients, including esotropia, is challenging. Careful diagnosis and management decision will determine the outcome of the patient’s condition.

The effect of strabismus surgery on psychosocial and functional quality of life

Aims: To evaluate the effect of strabismus surgery on psychosocial and functional quality of life. Methods: 50 adult strabismus patients who presented to our outpatient clinic with the complaint of strabismus in one eye were included in the study. Routine ophthalmologic examinations and strabismus controls were performed. With the diagnosis of monocular fixed eso/exotropia, unilateral horizontal muscle retraction and resection surgery were planned, and preoperative adult strabismus score (AS-20), Rosenberg self-esteem, body perception, and social appearance anxiety questionnaires were applied. A postoperative PD of 10 or less was considered success, and the questionnaires were repeated at the 2nd postoperative month. Results: The mean age of the patients was 21.54±3.95 (16-32) years. Twenty-two of the patients were female, and 28 were male. Pre-operative and post-operative strabismus AS-20 score, Rosenberg self-esteem, body perception, and social appearance anxiety scales showed statistically significant differences (p<0.05, p<0.001, p<0.001, p<0.001, p<0.001). Conclusion: Strabismus is an important disease that can cause difficulties in social life both in childhood and adulthood. The aim of strabismus surgery is to restore normal facial appearance as well as functional correction. Our study results showed that successful strabismus surgery can improve the psychosocial and functional quality of life.

Strabismus is more than a misalignment; a cross-sectional pilot study of HRQOL in Finnish strabismic adults referred to a university hospital.

To evaluate associations between the health-related quality of life (HRQOL) and demographic, self-reported strabismus-related and orthoptic status variables in Finnish strabismic adults. Participants (n = 137) of this study were adult patients who previously participated in the pilot study to translate and validate Adult Strabismus Questionnaire (AS-20) into Finnish. For this study, the participants' orthoptic status were collected among the previously obtained self-reported demographic and strabismus-related data. The refined AS-20 structure of 18 items and four subscales of self-perception, interaction, reading function and general function was used. Low scores on AS-20 indicate low HRQOL. The associations were evaluated with cross-tabulation and nonparametric methods of Mann-Whitney U and Kruskal-Wallis tests. Statistical significance was set at p < 0.05. Interaction subscale scores were the highest of all subscale scores among the participants. Age had an association with HRQOL in self-perception and the youngest participants had the lowest scores. Importantly, participants who did not experience diplopia suffered from lower self-perception and interaction but reported higher scores on reading function and general function subscales compared to the participants who experienced diplopia. Exotropia with or without vertical strabismus were most common types among the participants. The education background was not associated with HRQOL. Impacts of strabismus are similar in Finnish strabismic adults compared to international studies. Healthcare professionals and decision-makers should always consider the psychosocial impact of strabismus on patients without diplopia when making decisions on strabismus treatment and care processes.

Implementing strabismus-specific psychosocial questionnaires in everyday clinical practice: mental health and quality of life in the context of strabismus surgery

BackgroundStrabismus can have a great negative impact on the quality of life and the well-being of affected patients. In the past, these aspects were often neglected and, compared with somatic...

Long-term outcomes of single monocular resection-recession in adult sensory strabismus and factors affecting the postoperative drift.

The purpose of our study was to analyze the clinical characteristics and outcome of horizontal strabismus surgery in patients having sensory strabismus and to analyze the factors that affect the postoperative drift in these patients over a follow-up of three years. This was a retrospective case series. Patients aged ≥18 years, having low vision (visual acuity ≤20/60) in one eye, and undergoing horizontal strabismus surgery (standard recess-resect procedures) in the same eye were recruited. All patients were advised patching of the good eye six weeks prior and continued for six weeks post strabismus surgery. We excluded patients who had paralytic disorders, motility defects, or those with chronic systemic conditions. Patients with a minimum follow-up of three years were recruited. The study included 56 patients whose mean age was 22.9 ± 4.93 years. Exotropia (n = 38; 67.8%) was more common than esotropia (n = 18; 32.1%). Preoperative visual acuity was 1.1 ± 0.85 (range perception of light to 6/18p). The cause of low vision was amblyopia (n = 30; 53.5%) followed by trauma (n = 22; 39.2%). The mean preoperative distance deviation was 57.7 ± 15.5 PD in the primary position (range: 20-65 PD). The success rate of exotropia (78.9%) was more than esotropia (52.9%) at three years. Two patients with esotropia were overcorrected. All patients with exotropia showed an exotropic drift with time. The motor alignment after a single recession-resection procedure was satisfactory at the long-term in our cohort of sensory strabismus. The duration or extent of visual impairment had no relation to the postoperative outcome.

Improvement in health-related quality of life with Botulinum toxin A injection in acquired superior oblique palsy.

This study aimed to investigate the outcomes of Botulinum toxin A (BTA) injection into the inferior oblique (IO) muscle for the management of unilateral acute acquired superior oblique palsy (SOP) and to evaluate changes in health-related quality of life post-injection using the Adult Strabismus-20 (AS-20) questionnaire. A prospective cohort study was performed in patients with unilateral acute acquired SOP who received BTA injections. Four units of BTA were injected into the ipsilateral IO muscle. Ocular examinations were performed pre-and post-injection, including alignment, ocular movement, and cyclotorsion deviation. The patients' AS-20 questionnaire scores were analyzed. A total of 21 patients with acute acquired SOP were included. The initial median vertical deviation was 5 PD (range 1-16), which was improved to 0 PD (range 0-10) at both 1 and 6 months post-injection (p < 0.001 and p < 0.001, respectively). The median torsional deviation was 7° (range 2-18) at baseline and resolved to 0 degrees (range -3-5) at the 1-month and 0° (range -2-7) at the 6-month follow-up (p < 0.001 and p < 0.001, respectively). There were significant increases in the overall score (OAS), psychosocial subscale score (PSS), and functional subscale score (FSS) from baseline values at both the 1-month (p < 0.001, p < 0.001, and p = 0.001, respectively) and 6-month follow-up (all p < 0.001). Injecting BTA into the ipsilateral IO muscle successfully resolved vertical and torsional deviations and significantly improved quality-of-life scores. Our findings show that BTA treatment, as an early treatment for acute acquired SOP, can help patients by significantly improving their quality of life.

Missed appointments in a tertiary academic pediatric ophthalmology and adult strabismus service: cross-sectional study and literature review

To investigate the rate of missed appointments in a Canadian academic hospital-based pediatric ophthalmology and adult strabismus practice and the demographic and clinical factors associated with missed appointments. This cross-sectional study included all consecutive patients seen from June 1, 2018, to May 31, 2019. Multivariable logistic regression model assessed associations between clinical and demographic variables with no-show status. A literature review on evidence-based interventions to reduce no-show appointments in ophthalmology was performed. Of 3,922 visits, 718 (18.3%) were no-shows. Characteristics associated with no-shows included new patient (OR = 1.4; 95% CI, 1.1-1.7 [P = 0.001]), age 4-12 years (OR=1.6; 95% CI, 1.1-2.3 [P = 0.011]) or age 13-18 years (OR = 1.8; 95% CI, 1.2-2.7 [P = 0.007]) compared with age 19+ years, history of previous no-shows (OR = 2.2; 95% CI, 1.8-2.7 [P = 0.001]), referrals from nurse practitioners (OR = 1.8; 95% CI, 1.0-3.2 [P = 0.037]), nonsurgical diagnoses such as retinopathy of prematurity (OR = 3.2; 95% CI, 1.8-5.6 [P< 0.001]), and winter season (OR = 1.4; 95% CI, 1.2-1.7 [P < 0.001]). Missed appointments in our pediatric ophthalmology and strabismus academic center are more likely new patient referrals, prior no-shows, referrals from nurse practitioners, and nonsurgical diagnoses. These findings may facilitate targeted strategies to help improve utilization of healthcare resources.

Pediatric Ophthalmology Scope of Practice

ABSTRACT Purpose To determine practice patterns of pediatric ophthalmologists with respect to types of medical conditions cared for and age of patients treated due to limited data regarding pediatric ophthalmologists’ scope of practice. Methods A survey was sent to 1408 international and United States members of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) membership through the group’s internet listserv. Responses were collated and analyzed. Results Ninety members (6.4%) responded. 89% of respondents confine their practices to pediatric ophthalmology and adult strabismus. The percentages of respondents who provide primary surgical and medical treatment of the following conditions include 68% for ptosis and anterior orbital lesions, 49% for cataracts, 38% for uveitis, 25% for retinopathy of prematurity, 19% for glaucoma, and 7% for retinoblastoma. For conditions other than strabismus, 59% restrict their practice to patients less than 21 years of age. Conclusion Pediatric ophthalmologists provide primary medical and surgical care for children with a wide variety of ocular conditions, including complex disorders. Awareness of this variety of practice might prove beneficial in encouraging residents to consider careers in pediatric ophthalmology. Consequently, fellowship education in pediatric ophthalmology should include exposure to these areas.

AAPOS Adult Strabismus Committee's Report on the Status of Adult Strabismus Telemedicine.

To evaluate the utility of telemedicine in the treatment of adult patients with strabismus. A 27-question online survey was sent to ophthalmologists of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Adult Strabismus Committee. The questionnaire focused on the frequency of telemedicine utilization, the benefits in the diagnosis, follow-up, and treatment of adult strabismus, and barriers of current forms of remote patient visits. The survey was completed by 16 of 19 members of the committee. Most respondents (93.8%) reported 0 to 2 years of experience with telemedicine. Telemedicine was found to be useful for initial screening and follow-up of established patients with adult strabismus, mainly to reduce wait time for a subspecialist visit (46.7%). A successful telemedicine visit could be completed with a basic laptop (73.3%) or a camera (26.7%) or could be assisted by an orthoptist. Most participants agreed that common forms of adult strabismus (cranial nerve palsies, sagging eye syndrome, myogenic strabismus, and thyroid ophthalmopathy) could be examined via webcam. It was easier to analyze horizontal than vertical strabismus. Among the paralytic forms, sixth nerve palsy was the easiest one to assess. Latent forms of strabismus can be partially diagnosed and evaluated using telemedicine, but half of the respondents underlined the importance of in-person examinations in these cases. Sixty-nine percent believed that telemedicine could be a low-cost and time-efficient health service solution. Most members of the AAPOS Adult Strabismus Committee consider telemedicine to be a useful supplement to the current adult strabismus practice. [J Pediatr Ophthalmol Strabismus. 2023;60(6):386-389.].

Translation and validation of a questionnaire on the impact of strabismus on the quality of life of patients

Objective: To translate and validate the Adult Strabismus Quality of Life Questionnaire into Brazilian Portuguese. Methods: A cross-sectional study for linguistic and cross-cultural validation of the Adult Strabismus Quality of Life Questionnaire in order to assess the quality of life in patients with strabismus. We have followed previous published guidelines on translation process to ensure the equivalence between the original and translated versions. The final version was applied in a pilot study to evaluate concordance and its reliability and [...]

Health-Related Quality of Life in Adult Patients with Strabismus—Translation and Psychometric Testing of the Adult Strabismus Questionnaire (AS-20) into Finnish

(1) Strabismus has an impact on individuals' health-related quality of life. The impact should be assessed with valid patient-reported outcome measures such as the Adult Strabismus Questionnaire (AS-20). The AS-20 was further refined using a Rasch analysis for the American population. The aims of the study were to translate and culturally adapt the AS-20 into Finnish and to evaluate the psychometric properties of the Finnish AS-20. (2) The guidelines of the Professional Society for Health Economics and Outcomes Research steered the process and four items were added from the original data as Finnish additions. The construct and convergent validity and internal consistency were evaluated via psychometric testing for three potential Finnish AS-20 structures. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was applied. (3) The participants (n = 137) reported that the translation was clear and understandable. All structures showed high reliability and internal consistency as measured using Cronbach alpha values. The convergent validity assessed using Spearman's correlation coefficients between the structures and one item of Satisfaction with Life Scale indicated very low to moderate positive correlations. The construct validity evaluated using a confirmatory factor analysis revealed the refined AS-20 structure to be satisfactory. (4) The refined AS-20 can be used in clinical practice and research, but further validation is recommended.

Factors Influencing Stereopsis Outcomes in Adults Following Strabismus Surgery.

The aim of the study was to evaluate binocular vision after adult strabismus surgery and to investigate the predictive factors on improvement stereoacuity. Patients aged upper from 16 years who underwent strabismus surgery in our hospital reviewed retrospectively. Age, existence of amblyopia, pre-operative and postoperatively fusion ability, stereoacuity, and deviation angle were recorded. Patients were divided into two groups according to final stereoacuity; 200 sn/arc and lower: Good stereopsis (Group 1), upper 200 sn/arc: Poor stereopsis (Group 2). Characteristics were compared between groups. A total of 49 patients, who were 16-56 years of age, were included in the study. The mean follow-up time was 37.8 months (range 12-72 months). Of patients, 26 had improvement in stereopsis scores after surgery (53.0%). Group 1 includes 200 sn/arc and lower (n=18, 36.7%) and Group 2 includes higher than 200 sn/arc (n=31, 63.3%). The presence of amblyopia and higher refraction error was frequent significantly in Group 2 (p=0.01 and p=0.02, respectively). The existence of fusion postoperatively was significantly frequent in Group 1 (p=0.02). Type of strabismus and the amount of deviation angle were not found in a relationship with good stereopsis. In adults, surgical correction of horizontal deviation improves stereoacuity. Having no amblyopia, having fusion after surgery, and low refraction error are predictive for the improvement in stereoacuity.

Analgesia in Postoperative Adult Strabismus Patients.

This survey of pediatric ophthalmic surgeons on analgesia for postoperative adult strabismus patients indicates that 65% prescribed acetaminophen and/or nonsteroidal anti-inflammatory drugs (NSAIDs), and 12% to 16% prescribed opioids. Most surgeons reported reasonable control of pain regardless of analgesia. Acetaminophen and/or NSAIDs may adequately control pain, although certain circumstances may warrant opioid prescriptions. [J Pediatr Ophthalmol Strabismus. 2023;60(1):e5-e7.].

Prevalence and Clinical Characteristics of Adult Strabismus

Purpose: Strabismus is a condition in which the eyes are misaligned causing double vision. While it primarily affects pediatric patients, adults may also present with strabismus due to various etiologies, but the occurrence of these are not well-established. This study aims to elucidate the prevalence of adult strabismus and its clinical risk factors.&#x0D; Methods: This retrospective study reviewed charts of 1705 adult patient seen by the Indiana University School of Medicine Department of Ophthalmology between June 2016 and October 2020 for potential strabismus. Exclusion criteria included no diagnosis of strabismus or diplopia (n=42), not an adult patient (n=3), no charts available for review (n=105), and personal relation with a patient (n=3). Patient demographic, co-morbidity, ophthalmologic risk factor, and strabismus characteristic data was collected. Prevalence was calculated for each subclassification of strabismus, and clinical characteristics were discovered through calculation of odds ratios (OR).&#x0D; Results: 1551 patient charts were included. The prevalence of esotropia (ET), exotropia (XT), and hypertropia (HT) was found to be 42.41%, 43.8%, and 44.04%, respectively. Combined vertical and horizontal strabismus was seen in 29.91% of patients. Patients 65 years and older had increased odds of having ET and HT (OR 1.67, 95% confidence interval (CI) (1.35, 2.05); OR 1.79, CI (1.45, 2.20)) but lower odds of having XT than their younger counterparts (OR 0.40, CI (0.32, 0.50)). Women had reduced odds of having ET compared to men (OR 0.63, CI (0.51,0.78)). Patients with low visual acuity (logMAR≥1) had much lower odds of having ET and HT (OR 0.43, CI (0.24, 0.78); OR 0.06, CI (0.02, 0.20)) but over four times greater odds of having XT (OR 4.34, CI (2.41, 7.84)). Hypertension, diabetes, and hyperlipidemia also affected the odds of having strabismus.&#x0D; Conclusion: Adult strabismus remains a poorly understood condition; further research is necessary to facilitate individualization of care.

The Economic Downturn of Pediatric Ophthalmology and Its Impact on Access to Eye Care.

To discuss the economic downturn of pediatric ophthalmology in the setting of an alarming decline in the number of residents pursuing pediatric ophthalmology and its impact on limiting access to eye care. Survey studies and articles examining the recent economic impact of reimbursement cuts and practice pattern changes in pediatric ophthalmology were reviewed. Population data from the 2020 U.S. Census Bureau and the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) were analyzed to illustrate provider-to-population relationships by state. Survey studies demonstrated a deteriorating economic situation marked by progression in reimbursement cuts, reductions in pediatric ophthalmologists accepting Medicaid patients, and dwindling numbers of residents pursuing pediatric ophthalmology fellowships. Provider-to-population relationships revealed that pediatric ophthalmologists are not evenly distributed to meet population demand, and that many states are suffering from a shortage of pediatric ophthalmologists. Furthermore, many states with high percentages of Medicaid coverage simultaneously have lower AAPOS members/million person ratios. The simple economic principles of supply and demand reveal a crisis in access to pediatric eye and adult strabismus care. The economic downtown and change in practice patterns may produce rippling effects outside pediatric ophthalmology in fields such as pediatrics and comprehensive ophthalmology. An interdisciplinary effort among health care providers and governmental officials is needed to revive the field of pediatric ophthalmology and improve access to eye care. [J Pediatr Ophthalmol Strabismus. 2023;60(1):18-24.].

Effect of Intranasal Dexamethasone on the Incidence of Nausea and Vomiting After Adult Strabismus Surgery.

Due to the high prevalence of postoperative nausea and vomiting (PONV), this study aimed to determine the preventive effect of intranasal dexamethasone on the incidence of nausea and vomiting after adult strabismus surgery. This randomized clinical trial study was performed on 72 patient candidates for strabismus surgery at Feiz University Hospital in Isfahan in 2020. Patients were divided into 2 groups of 36 with random allocation software and entered into the study. After induction of similar anesthesia, endotracheal intubation was performed in patients. Immediately after inflating the cuff, the first group (intranasal dexamethasone (ND)) received 1 mL of dexamethasone (4 mg) per nasal passage, and the second group (intranasal normal saline (NS)) received 1 mL of normal saline per nasal passage. Patients of the 2 groups were evaluated and compared at first 2 hours and 2 - 24 hours after surgery for the incidence and severity of nausea and vomiting, and pain after surgery. Data were analyzed using SPSS software version 23. There were no significant differences in terms of age (P = 0.304), weight (P = 0.21), gender (P = 0.81), and American Society of Anesthesiologists (ASA) Physical Status class (P = 1) between the 2 groups. In the first 2 hours after surgery, the incidence of nausea (P = 0.034) and its severity (P = 0.019) was significantly lower in the ND group compared to the NS group. Also, 24 hours after surgery, the incidence of nausea (P = 0.38) and its severity (P = 0.55) were insignificantly lower in the ND group. Both groups showed no significant difference in the incidence of vomiting at 2 hours (P = 0.11) and 24 hours (P = 0.16) postoperative. Two hours after surgery, the incidence of pain (P = 0.001) and its severity (P < 0.001), and also 24 hours after surgery, the incidence of pain (P < 0.001) and its severity (P < 0.001) were significantly lower in the ND group. Getting ondansetron (P = 0.023) and pethidine (P < 0.001), extubation time (P < 0.001), and recovery time (P = 0.03) were significantly lower in the ND group. Patients' satisfaction was significantly higher in the ND group compared to the NS group (P = 0.031). The findings of the present study show that the intranasal use of dexamethasone with a dose of 8 mg compared to saline is associated with a decrease in PONV and postoperative pain, a decrease in the use of ondansetron and pethidine, and an increase in patient's satisfaction. Intranasal use of dexamethasone may be an effective and safe method, especially in cases where we do not have access to an intravenous line.

Utilising Virtual Clinics and Orthoptists to Aid COVID-19 Service Recovery in Adult Strabismus.

The Sheffield Virtual Adult Strabismus service was already well established and was put to real-time trial during the COVID-19 pandemic. We describe a multi-disciplinary adaptation to offer a safe and effective service delivery. We evaluate the efficacy of a virtual strabismus service during the pandemic to meet clinical demand, streamline patient care, balance care delivery and optimise medical input. Prospective data analysis from the virtual strabismus clinics dated from January 2015 to November 2021. All information was captured at first consultation with comprehensive specialist Orthoptic assessment and imaging; then reviewed by a strabismus consultant for clinical outcome. Management was discussed virtually with patients by the consultant. Pre-COVID (January 2015-March 2020), 1,068 appointments were offered. During COVID (July 2020-November 2021), 442 appointments were offered. Clinical capacity increased to meet demand. Within two months of service re-opening, first appointment mean waiting time reduced below 18 weeks. During COVID, 24.6% of patients were listed for procedures after first visit. Face-to-face medical follow up for non-surgical cases reduced from 47.7% to 16.3%. Virtual strabismus services offer flexible, safe and effective ways to meet fluctuating referral patterns and maximise limited time and resources. Orthoptists are uniquely essential and highly valued keyworkers to conservatively manage non-surgical strabismus. Utilising the skillsets of Allied Health Professionals (AHPs) across the NHS is crucial to sustain ongoing clinical demand and patient care.

The Economic Factors Impacting the Viability of Pediatric Ophthalmology.

To create a survey that assesses the economic factors impacting the viability of pediatric ophthalmology between January 2021 and July 2022. A 12-question survey was distributed to United States-based pediatric ophthalmologists on the American Association for Pediatric Ophthalmology and Strabismus discussion board and various social media fora. Demographic, economic, and workforce pattern data were collected and analyzed. A total of 243 pediatric ophthalmologists completed the survey. One hundred seven (44.0%) respondents reported a surgical revenue decrease between 10% and 25%, 117 (48.1%) a clinical revenue decrease of less than 10%, 111 (45.6%) an overall income decrease of less than 10%, and 127 (52.2%) an overhead cost increase between 10% and 25%. Seventy-two (29.6%) respondents reported subsidizing income with pursuits outside of pediatric ophthalmology, 27 (11.1%) stopped operating due to reimbursement cuts, 75 (30.8%) limited the number of Medicaid or other public funded patients, 16 (6.5%) retired in the past 3 years, and 92 (37.8%) would not recommend a resident pursue a pediatric ophthalmology fellowship. There is a potential upheaval in the field of pediatric ophthalmology marked by increasing levels of disillusionment among current providers, a progressive decline in the number of trainees pursuing fellowship programs, and workforce issues suggestive of diversification of practice patterns outside of pediatric ophthalmology. The current economic crisis, in conjunction with these complex workforce issues, is and will continue to create a shortage of practicing pediatric ophthalmologists, seriously limiting access to pediatric and adult strabismus eye care. [J Pediatr Ophthalmol Strabismus. 2022;59(6):362-368.].