Strabismus Surgery Improves Vision in Older Adults

TOPLINE:

Strabismus surgery resolves diplopia or double vision in three fourths of senior patients aged > 80 years after the initial procedure, with the resolution rate increasing with additional surgeries.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to assess the efficacy and complications associated with strabismus surgery in 165 older patients (mean age, 84 years; 52% women) who underwent surgical correction for eye misalignment at the University of California, Los Angeles, between 2014 and 2024.
• Measurements of strabismus were taken in the primary position for both far and near distances. Diplopia was the chief complaint in 156 patients (94%); nine patients sought surgery for cosmetic reasons (6%).
• Surgical details that were recorded included the muscles operated on, type of anesthesia used, American Society of Anesthesiologists status, use of adjustable sutures, and rate of reoperation.
• Topical or local injection anesthesia was recommended for patients deemed high risk for general anesthesia or on the basis of patient preference.
• The mean follow-up duration after surgery was 333 days, with less than 7 days of follow-up noted for 10 patients.
• Surgical procedures included standard recessions and resections, and adjustable sutures were used in 88% of patients. No intraoperative complications were reported.

TAKEAWAY:

• Binocular diplopia was resolved in 75% of patients after initial surgery; this number rose to 87% after additional procedures. Reoperation for persistent diplopia was required for 13% patients.
• Sagging eye syndrome was the most common diagnosis, noted in 46% of patients. Surgery was performed under general anesthesia for 30% of patients, while 70% received topical or local anesthesia.
• The requirement for prisms decreased postoperatively for eye misalignments, from 70.0% to 0.02% (n = 1) in patients with esotropia and from 73% to 9% in those with hypertropia. Improvement in near stereopsis was noted in 34% of patients after surgery.

IN PRACTICE:

“This series demonstrates that patients aged over 80 years can be good candidates for strabismus surgeries, under both general, local, or topical anesthesia,” the authors of the study wrote. 

SOURCE:

The study was led by Veronika Yehezkeli, MD, from the Stein Eye Institute and Department of Ophthalmology at University of California, Los Angeles. It was published online on January 31, 2025, in the American Journal of Ophthalmology. 

LIMITATIONS:

The study was retrospective in nature and, hence, may have limited ability to establish causality. The involvement of three different surgeons may have introduced variability in surgical techniques and outcomes. Data on patient satisfaction were not available.

DISCLOSURES:

This study was supported by grants from the National Eye Institute and an Unrestricted Grant to the University of California, Los Angeles, Department of Ophthalmology from Research to Prevent Blindness. No relevant conflicts of interest were disclosed by the authors. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.