Adult Strabismus Research Articles

Gain beyond cosmesis: demonstration of psychosocial and functional gains following successful strabismus surgery using the adult strabismus questionnaire adult strabismus 20.

Background:Strabismus adversely affects psychosocial and functional aspects; while its correction impacts positively.Aim:The aim was to evaluate the gains in scores: Overall scores (OASs), psychosocial subscale scores (PSSs) and functional subscale scores (FSSs) following successful surgical alignment.Settings and Design:We evaluated changed scores in the adult strabismus 20 (AS-20) questionnaire, administered before and after successful surgery.Materials and Methods:Thirty adults horizontal strabismics, were administered the AS-20, at baseline, and at 6-week and 3-month. Group-wise analysis was carried out based on gender, strabismus type (esotropia [ET] or exotropia [XT]), back-ground and amblyopia.Statistical Analysis:We used Wilcoxon, and Mann-Whitney U-tests. Significance was set at P ≤ 0.05.Results:At baseline, there were no significant differences within the groups, except that those with amblyopia significantly scored less than nonamblyopes in OAS (median scores: 53.8 vs. 71.3; P = 0.009) and FSS (56.3 vs. 85.3; P = 0.009). OAS, PSS and FSS showed significant gains at 6-week and 3-month (all Wilcoxon P < 0.001). Compared with males, females showed significantly more gain at 3-month (OAS: 37.9 vs. 28.7; P = 0.02), on account of PSS gain (49.6 vs. 37.5; P = 0.01). The ET performed better than XT only on the FSS at 6-week (28.7 vs. 15.0; P = 0.02). Vis-à-vis the nonamblyopes, the amblyopes showed significantly more benefit at 6-week alone (OAS: 18.7 vs. 28.7; P = 0.04), largely due to gains in PSS.Conclusions:Successful strabismus surgery has demonstrated significant gains in psychosocial, functional and overall functions. There is some evidence that gains may be more in females; with a trend to better outcomes in ET and amblyopes up to 6-week.

A 1-Year Review of Amblyopia and Strabismus Research.

This current review highlights some of the literature published in the past year from April 2013 to May 2014. Literature Review. The present review is based on an extended search for pertinent articles on amblyopia and strabismus published during the specified period. Many articles are often not very comparable to one another because of a lack of randomized clinical trials with most of the studies being retrospective in nature. There is often disagreement on some terminology. Typically, the definition of binocular vision is rarely related to the tests used for evaluating it. The authors conclude that adult strabismus patients seem to gain benefits from corrective surgery not only for their ocular misalignment, but also for social anxiety levels that may be associated with improvements in their quality of life and disability levels.

Incidence, types, and lifetime risk of adult-onset strabismus.

To describe the incidence and types of adult-onset strabismus in a geographically defined population. Retrospectively reviewed population-based cohort. All adult (≥19 years of age) residents of Olmsted County, Minnesota, diagnosed with new-onset adult strabismus from January 1, 1985, through December 31,2004. The medical records of all potential cases identified by the resources of the Rochester Epidemiology Project were reviewed. Incidence rates for adult-onset strabismus and its types. Seven hundred fifty-three cases of new-onset adult strabismus were identified during the 20-year period, yielding an annual age- and gender-adjusted incidence rate of 54.1 cases (95% confidence interval, 50.2-58.0) per 100 000 individuals 19 years of age and older. The 4 most common types of new-onset strabismus were paralytic (44.2% of cases), convergence insufficiency (15.7%), small-angle hypertropia (13.3%), and divergence insufficiency (10.6%). The incidence of adult-onset strabismus overall and its 4 mostcommon forms significantly increased with age (P <0.001 for all), with a peak incidence in the eighth decade of life. The lifetime risk of being diagnosed with adult-onset strabismus was 4.0% in women and 3.9% in men. Paralytic strabismus was the most common subtype of new-onset adult strabismus in this population-based cohort. All of the most common forms of adult-onset strabismus increased with age, especially after the sixth decade of life. Further characterization of strabismus types found in this study is warranted to better define this disorder.

The Psychological Impact Of Strabismus: Does The Angle Really Matter?

Introduction: The psychological impact of strabismus is well recognized. Patients with strabismus have lower levels of psychological well being compared to normal controls. Few studies have evaluated the relationship between levels of psychological distress and the angle of deviation, age, sex, presence of diplopia, visual acuity and direction of deviation.Methods: 50 patients with strabismus who attended the adult strabismus clinic were included in this questionnaire based prospective study. The Psychological Impact questionnaire was used to assess the psychological impact of noticeable strabismus. We measured the angle of deviation, age, sex, presence of diplopia, visual acuity and direction of deviation and correlated these with psychological impact scores. Student’s t-test and Pearson’s correlation coefficient (r) were used in statistical analysis.Results: The average age was 48 years (range 15-84) and there were 26 females and 24 males. There was no correlation between psychological impact score and the maximum degree of horizontal deviation r = 0.02 (95% CI −0.26 to 0.29), p = 0.9, the maximum angle of vertical deviation r = 0.26 (95% CI −0.01 to 0.51), p = 0.06, age r = −0.09 (95% CI −0.36 to 0.19), p = 0.5, sex (p = 0.96), presence of diplopia (p = 0.6), visual acuity of the worse eye r = −0.01 (95% CI −0.29 to 0.27), p = 0.9 and direction of deviation (p = 0.8 for eso-deviations compared to exo-deviations, p = 0.4 for horizontal compared to vertical deviations). There was a slight negative correlation between psychological impact score and visual acuity of the better eye r = −0.28 (95% CI −0.52 to −0.01), p = 0.04.Conclusion: The psychological impact of strabismus does not appear to be related to the patient’s angle of deviation, age, sex, presence of diplopia, visual acuity or direction of deviation. Larger studies are required using strabismus specific tools for evaluating psychological impact to further investigate these findings.

Does restoration of binocular vision make any difference in the quality of life in adult strabismus

BackgroundTo report the effect of restoration of binocular functions in adult strabismus on the health-related quality of life (HRQOL).Methods61 adults undergoing strabismus surgery completed Adult Strabismus-20 (AS-20) and Amblyopia and...

Improvement in patients' quality-of-life following strabismus surgery: evaluation of postoperative outcomes using the Adult Strabismus 20 (AS-20) score

Quantification of the psychosocial effects of manifest strabismus has been made possible by the introduction of the Adult Strabismus 20 (AS-20) questionnaire. We investigated the effects of strabismus surgery and patient demographics on the pre- and postoperative AS-20 scores. A prospective, cohort study of adult patients undergoing strabismus surgery. Full pre- and postoperative orthoptic measurements were analysed and compared with the AS-20 total scores and its subscales (psychosocial and functional). Any relationship between: gender; direction; and size of preoperative deviation and the changes in AS-20 score was investigated. Eighty-six patients were included with a follow-up of 91 days following surgery. Median deviation preoperatively was 30.5 prism diopters (PD) and the median preoperative AS-20 score was 45. Postoperatively, the median deviation was 8 PD and the AS-20 score was significantly (Z=-7.83, P<0.0001) higher at 73.1. Females have a lower preoperative AS-20 score (P=0.01) but show a greater improvement in scores following surgery compared with males (P=0.058). There is a close correlation between change in AS-20 score and change in deviation size (r=0.291, P=0.006). Strabismus surgery gives a highly significant improvement in quality-of-life scores. Females gain more benefit from surgery and there is a greater improvement in the score with larger changes in deviation size. The smaller the postoperative angle, the larger the final AS-20 score.

Development and Evaluation of a Chinese Version of the Adult Strabismus Questionnaire (AS-20)

ABSTRACTPurpose: The 20-item Adult Strabismus Quality of Life Questionnaire (AS-20) was developed in the United States to assess health-related quality of life (HRQOL) of adult patients with strabismus. At present, no questionnaire is available for assessing HRQOL specifically for adult patients with strabismus in China. A Chinese version of the AS-20 (CAS-20) was developed and its reliability and validity evaluated in adult patients with strabismus in China.Methods: The AS-20 was translated into Chinese. A total of 102 adults with strabismus and 102 visually healthy adult controls were recruited to answer the 5-level Likert items of the CAS-20. Demographic (age and sex) and clinical data of the recruited subjects were documented. Internal consistency, test-retest reliability, correlations between items and their respective subscale, and construct validity were evaluated to assess questionnaire reliability and validity.Results: The number of responses for each item was calculated, as well as individual items’ correlation with their respective subscale. Cronbach’s α coefficient for the two subscales and the CAS-20 were satisfactory (0.846, 0.819, 0.883, respectively). The intra-class correlation coefficient for test-retest reliability was 0.723–0.862. Patients with strabismus had significantly lower scores on the CAS-20 than controls. Factor analysis identified six principal factors, and could be grouped into two subscales. The results supported the construct validity of the CAS-20.Conclusion: The CAS-20 presented satisfactory reliability and validity in our study. It is suggested that the questionnaire can be applied in clinical trials or research for Chinese patients with strabismus.

Quantifying Diplopia with a Questionnaire

To report a diplopia questionnaire (DQ) with a data-driven scoring algorithm. Cross-sectional study. To optimize questionnaire scoring, 147 adults with diplopic strabismus completed both the DQ and the Adult Strabismus-20 (AS-20) health-related quality-of-life (HRQOL) questionnaire. To assess test-retest reliability, 117 adults with diplopic strabismus. To assess responsiveness to surgery, 42 adults (46 surgeries). The 10-item AS-20 function subscale score (scored 0-100) was defined as the gold standard for severity. A range of weights was assigned to the responses and the gaze positions (from equal weighting to greater weighting of primary and reading). Combining all response option weights with all gaze position weights yielded 382848 scoring algorithms. We then calculated 382848 Spearman rank correlation coefficients comparing each algorithm with the AS-20 function subscale score. To optimize scoring, Spearman rank correlation coefficients (measuring agreement) between DQ scores and AS-20 function subscale scores. For test-retest reliability, 95% limits of agreement and intraclass correlation coefficient (ICC). For responsiveness, change in DQ score. For the 382 848 possible scoring algorithms, correlations with AS-20 function subscale score ranged from -0.64 (best correlated) to -0.55. The best-correlated algorithm had response option weights of 5 for rarely, 50 for sometimes, and 75 for often, and gaze position weights of 40 for straight ahead in the distance, 40 for reading, 1 for up, 8 for down, 4 for right, 4 for left, and 3 for other, totaling 100. There was excellent test-retest reliability with an ICC of 0.89 (95% confidence interval, 0.84-0.92), and 95% limits of agreement were 30.9 points. The DQ score was responsive to surgery with a mean change of 51 ± 34 (P<0.001). We have developed a data-driven scoring algorithm for the DQ, rating diplopia symptoms from 0 to 100. On the basis of correlations with HRQOL, straight-ahead and reading positions should be highly weighted. The DQ has excellent test-retest reliability and responsiveness, and may be useful in both clinical and research settings.

Choice of conjunctival incisions for horizontal rectus muscle surgery—a survey of American Association for Pediatric Ophthalmology and Strabismus members

To assess the use of limbal versus fornix conjunctival incisions in primary and repeat horizontal rectus muscle surgeries among pediatric ophthalmologists and adult strabismus surgeons. A 2-page questionnaire was mailed to members of the American Association for Pediatric Ophthalmology and Adult Strabismus. Participants were asked about their use of limbal, fornix, or other incision types in their pediatric and adult strabismus patient population. A total of 1,022 questionnaires were circulated. The net overall response rate was 27.8%. For first-time strabismus surgeries in pediatric patients, 40.8% of respondents used limbal incisions in the majority of their cases, 58.1% used fornix incisions, and 1.1% used other incision types. For reoperations, 58.1% used limbal-based incisions, 39.1% used fornix incisions, and 2.1% used other incision types. In the majority of their primary surgeries on adults, 40.1% used limbal incisions, 53.5% preferred fornix incisions, 1.4% used other incision types, and 4.9% answered "not applicable" (available for respondents who operated exclusively on either children or adults). On reoperations, limbal incisions were used by 63.4% of respondents, 29.9% used fornix incisions, 1.4% used other incision types, and 5.3% answered "not applicable." Among those surveyed, limbal incisions were preferred for greater intraoperative exposure and better teaching of junior surgeons; fornix incisions were thought to cause less postoperative pain and inflammation and lead to more rapid soft-tissue healing.

The art and science of examining the child

Purpose/RelevanceTo improve patient care by increasing the understanding of the basic principles and skills in the pediatric ophthalmology practice.Target AudienceOphthalmic technical personnel who work with pediatric ophthalmologists.Current PracticeThe fundamental differences in working with pediatric ophthalmology patients are frequently over looked in the education of ophthalmic technical personnel. Members of the pediatric patient care staff may enter the pediatric practice well trained in the care of adult ophthalmology patients but their skill sets and knowledge are inadequate for optimal care of the pediatric patient.Best PracticeOphthalmic Technical Personnel should have the opportunity to learn the elements of an age appropriate examination and understand the importance of each component.Expected OutcomesAfter completing the workshop, the technical personnel should be able to gather more accurate information and use critical thinking skills to determine the appropriate ancillary tests. This in turn will translate into better information for the physicians and afford the patient a higher level of care more efficiently with increased patient satisfaction during the visit.FormatThe workshop will be a combination of didactic lectures, question and answer sessions and hands-on activities where the participants will practice the skills they have been taught.SummaryBeginning with the basics of history taking we will build on them to teach age-appropriate visual acuity testing and sensory testing and the essentials of refractive errors, amblyopia and strabismus. Participants will also be given education in the areas of color vision, pupil evaluation and adult strabismus. Purpose/RelevanceTo improve patient care by increasing the understanding of the basic principles and skills in the pediatric ophthalmology practice. To improve patient care by increasing the understanding of the basic principles and skills in the pediatric ophthalmology practice. Target AudienceOphthalmic technical personnel who work with pediatric ophthalmologists. Ophthalmic technical personnel who work with pediatric ophthalmologists. Current PracticeThe fundamental differences in working with pediatric ophthalmology patients are frequently over looked in the education of ophthalmic technical personnel. Members of the pediatric patient care staff may enter the pediatric practice well trained in the care of adult ophthalmology patients but their skill sets and knowledge are inadequate for optimal care of the pediatric patient. The fundamental differences in working with pediatric ophthalmology patients are frequently over looked in the education of ophthalmic technical personnel. Members of the pediatric patient care staff may enter the pediatric practice well trained in the care of adult ophthalmology patients but their skill sets and knowledge are inadequate for optimal care of the pediatric patient. Best PracticeOphthalmic Technical Personnel should have the opportunity to learn the elements of an age appropriate examination and understand the importance of each component. Ophthalmic Technical Personnel should have the opportunity to learn the elements of an age appropriate examination and understand the importance of each component. Expected OutcomesAfter completing the workshop, the technical personnel should be able to gather more accurate information and use critical thinking skills to determine the appropriate ancillary tests. This in turn will translate into better information for the physicians and afford the patient a higher level of care more efficiently with increased patient satisfaction during the visit. After completing the workshop, the technical personnel should be able to gather more accurate information and use critical thinking skills to determine the appropriate ancillary tests. This in turn will translate into better information for the physicians and afford the patient a higher level of care more efficiently with increased patient satisfaction during the visit. FormatThe workshop will be a combination of didactic lectures, question and answer sessions and hands-on activities where the participants will practice the skills they have been taught. The workshop will be a combination of didactic lectures, question and answer sessions and hands-on activities where the participants will practice the skills they have been taught. SummaryBeginning with the basics of history taking we will build on them to teach age-appropriate visual acuity testing and sensory testing and the essentials of refractive errors, amblyopia and strabismus. Participants will also be given education in the areas of color vision, pupil evaluation and adult strabismus. Beginning with the basics of history taking we will build on them to teach age-appropriate visual acuity testing and sensory testing and the essentials of refractive errors, amblyopia and strabismus. Participants will also be given education in the areas of color vision, pupil evaluation and adult strabismus.

Development and application of the Chinese version of the adult strabismus quality of life questionnaire (AS-20): a cross-sectional study

BackgroundPatients with strabismus experience visual dysfunction, self-image disorders, low self-esteem, and social and emotional barriers, which adversely influence their health-related quality of life (HRQoL). Currently no strabismus-specific questionnaire is available in China to identify patients’ quality of life and to evaluate the effectiveness of strabismus treatment. The aims of the present study were to validate the Chinese-language version of the Adult Strabismus Quality of Life Questionnaire (AS-20) and to evaluate the impacts of strabismus on the quality of life among Chinese strabismus patients.MethodsTwo hundred and fifty-five Chinese adults with strabismus, one hundred visually normal adults and one hundred patients with other eye diseases completed the Chinese version of AS-20. Psychometric properties of the Chinese AS-20 were examined by Cronbach’s α coefficient, test-retest and split-half reliability, and construct and criterion-related validity. Independent-samples t test and one-way ANOVA analyses were conducted to explore the impact of demographic factors and clinical characteristics on HRQoL in Chinese strabismic adults.ResultsThe final AS-20 in Chinese (AS-C) included 18 items and two subscales: psychosocial (12 items) and function (6 items). The Cronbach’s α was 0.908 for overall scale, with 0.913 and 0.808 for 'psychosocial’ and 'function’ subscales respectively, indicating high internal consistency reliability. The mean of the overall AS-C score among strabismus patients was 62.80 ± 18.94, significantly lower than that in visually normal adults (t = -18.693, P < 0.001), and in patients with other eye diseases (t = -5.512, P < 0.001).ConclusionsThe AS-C is a culturally appropriate tool to evaluate the HRQoL in Chinese strabismus adults. The psychosocial health well-being and overall quality of life in strabismic patients should receive greater emphasis.

Mini-plication to treat small-angle strabismus: A minimally invasive procedure

Mini-plication is a new rectus muscle tightening procedure for the correction of small-angle strabismus that can be performed under topical anesthesia. The purpose of this study was to report the outcomes of mini-rectus muscle plication. We retrospectively reviewed the medical records of patients who underwent mini-plication. In this procedure, 6-0 polyglactin 910 suture was secured to the central 3 to 4mm of the muscle belly 5 mm posterior to the insertion and was then passed through the sclera just anterior to the muscle insertion to plicate the central portion of the muscle.This differs from the standard procedure, in which the entire width of the muscle is plicated. Two groups were analyzed: those who underwent mini-plication alone andthose who underwent mini-plication after prior antagonist muscle-weakening surgery. Our review identified nine patients aged 5 to 78 years. Topical anesthesia was used for all adults, who experienced no local or systemic complications. Mini-plication reduced vertical and horizontal deviations an average (± SD) of 6.7(Δ)±3.5(Δ). The mini-plication-only group (3 patients) had an average postoperative correction of 5.5(Δ) ± 2.6(Δ); the prior surgery group (6 patients), an average of 9(Δ)±2.7(Δ). Diplopia was noted in 50% of the adults preoperatively and none postoperatively. All patients experienced a decrease in strabismus, with an average outcome of <5(Δ) of postoperative deviation. Mini-plication, which can be performed under topical anesthesia, corrected small deviations and was especially useful for adult strabismus patients with diplopia.

Is Presoaking Suture Material Prior to Strabismus Surgery Appropriate?

Dr. Nelson has no financial or proprietary interest in the materials presented herein. doi: 10.3928/01913913-20120523-01 The incidence of perioperative inflammation after strabismus surgery is uncommon. Many of these cases may be related to when there is prolongation of the suture material dissolving, creating conjunctival injection around the suture. This phenomenon is more common in adult strabismus surgery patients. The incidence of endophthalmitis after strabismus surgery is extremely rare; in this issue, Eustis and Rhodes estimate it as 1 in 35,000 to 1 in 185,000 cases following strabismus surgery. These authors noted that in a prospective randomized analysis that the contamination rate of suture material use in strabismus surgery was least when the suture was pre-soaked with antiseptic and antibiotic/steroid combination compared to sutures without pretreatment or soaked just with antibiotic/steroid combination. Unfortunately, the authors did not identify the pathogen contaminating the sutures. Many of the pathogens were most likely normal flora. Because the incidence of endophthalmitis following strabismus surgery is rare and no specific pathogens were identified in Eustis and Rhodes’ study, further prospective studies may help to determine whether presoaking sutures prior to strabismus surgery are appropriate.

Evaluation of the Adult Strabismus-20 (AS-20) Questionnaire Using Rasch Analysis

To further refine the Adult Strabismus 20 (AS-20) health-related quality of life (HRQOL) questionnaire using Rasch analysis. Rasch analysis was performed independently on the original AS-20 using the following steps: dimensionality, response ordering, local dependence, infit and outfit analyses, differential item functioning, subject targeting, and confirmatory dimensionality. Two subscales were present in each of the original AS-20 subscales, for a total of 4 subscales, which were labeled "self-perception," "interaction," "reading function," and "general function." Response ordering was appropriate for 3 of the subscales but required reduction to 4 response options for the fourth subscale. No notable local dependence was found for any subscale. As a result of fit analysis, 2 items were removed, 1 each from 2 subscales. No significant differential item functioning was seen for sex or age. The resulting 5-item self-perception subscale and 4-item reading function subscale are reliable and target the adult strabismus patient cohort appropriately. The resulting 5-item interaction subscale and 4-item general function subscale have less than optimal reliability. The AS-20 benefits from reduction to 4 subscales (self-perception, interaction, reading function, and general function) and reducing the response options in the general function subscale from 5 to 4 options. The refined AS-20 may prove to be even more responsive to HRQOL changes in adult strabismus following treatment or changes over time.

Comparing Outcome Criteria Performance in Adult Strabismus Surgery

To evaluate the performance of motor, diplopia, and health-related quality of life (HRQOL) criteria when analyzing outcomes of adult strabismus surgery. Cohort study. We studied 159 adults undergoing 171 strabismus surgeries. All patients underwent clinical assessment preoperatively and 6 weeks postoperatively, including completion of Adult Strabismus-20 HRQOL questionnaires. Preoperatively, strabismus was classified as either diplopic (n = 117), nondiplopic (n = 38), or atypical diplopic (n = 16). To assess performance of motor, diplopia, and HRQOL criteria, success was defined a priori and applied separately and in combinations. For success: (1) motor criteria, <10 prism diopters by simultaneous prism cover test; (2) diplopia criteria, none or only rare in primary distance and for reading; (3) HRQOL criteria, exceeding previously reported 95% limits of agreement (LOA). Surgical success rate when applying motor, diplopia, and HRQOL criteria alone and in combinations. Overall, success rates were 90% for motor criteria, 74% for diplopia criteria, and 60% for HRQOL criteria. Combining criteria, the highest success rate was for motor plus diplopia criteria (67%) and the lowest success rate was when combining motor, diplopia, and HRQOL criteria (50%). Applying motor criteria alone yields the highest success rates when evaluating outcomes in adult strabismus surgery, but motor criteria do not fully represent the patient's postoperative status. Combining diplopia criteria with motor criteria provides a more clinically relevant standard for judging the success of adult strabismus surgery. For HRQOL criteria, exceeding 95% LOA at 6 weeks postoperatively seems to be a difficult hurdle to clear for some individual patients, and evaluating change in HRQOL score may be more useful in cohort studies.

The effect on quality of life of long-term botulinum toxin A injections to maintain ocular alignment in adult patients with strabismus

BackgroundThere is considerable evidence to show that strabismus patients report their quality of life (QoL) as lower than normal controls. While the majority of patients with strabismus are treated with...

Refining the Adult Strabismus-20 (AS-20) questionnaire

Rasch analysis provides a rigorous method of refining and scoring health-related quality of life (HRQOL) questionnaires. We have recently applied Rasch analysis to the Adult Strabismus-20 (AS-20) questionnaire and now report the responsiveness of a Rasch-Modified AS-20.

Changes in Health-Related Quality of Life 1 Year Following Strabismus Surgery

To report changes in health-related quality of life (HRQOL) 1 year following strabismus surgery. Retrospective cohort study. Seventy-three adults undergoing strabismus surgery in a single clinical practice completed the Adult Strabismus-20 (AS-20) HRQOL questionnaire preoperatively and at 6 weeks and 1 year postoperatively. All included adults were successfully aligned at 6 weeks postoperatively. Success was defined based on clinical criteria. Change in AS-20 psychosocial and function scores was evaluated as: 1) difference in scores between 6 weeks and 1 year postoperatively and 2) proportions exceeding previously published limits of agreement at 6 weeks and 1 year. For patients successfully aligned at both 6 weeks and 1 year (n=51), further improvement in median scores was seen from 6 weeks to 1 year for both the psychosocial scale (83.8 vs 93.8; P<.0001) and the function scale (72.5 vs 77.5; P=.007). Also, a greater proportion exceeded limits of agreement at 1 year than at 6 weeks (psychosocial: 48% vs 30%; P=.007, function: 67% vs 51%; P=.01). For patients who became partial success (n=18) or failure (n=4) at 1 year there was a numerical decrease in scores at 1 year. Adult strabismus patients who remain successfully aligned show continued improvement in both psychosocial and function scores from 6 weeks to 1 year postoperatively, indicating that improvement in HRQOL is long-lasting. Evaluation of HRQOL should be considered when reporting strabismus surgery outcomes in clinical trials, and may prove helpful in assessing outcomes in clinical practice.

Adult strabismus workshop

Relevance: The surgical treatment of the adult with strabismus comprises a significant portion of the clinical and surgical volume of many pediatric ophthalmologists. This workshop is a continuum of prior workshops on adult strabismus.

Vertical Deviations Secondary to Supranuclear Origins

A vertical deviation is a relatively common finding in a pediatric ophthalmology and adult strabismus practice. Fortunately, vertical deviations secondary to supranuclear entities occur somewhat less frequently, given the neurological implications associated with many of them. Because of the lower incidence of supranuclear vertical deviations, they can easily be overlooked or misdiagnosed if special care is not taken in its evaluation. The purpose of this paper is to assist the clinician in recognizing vertical deviations specific to supranuclear disorders, the associated findings, and the diagnostic tools geared toward them.