The value of strabismus surgery

Strabismus surgery is indicated for a variety of conditions stemming from misalignment of the eyes, abnormal head posture, and nystagmus. Although part of the value of such surgery lies in the fact that it improves appearance, it differs from cosmetic surgery, because, unlike the latter, it is designed to restore only normal configuration for ocular alignment--straight and/or aligned with the object of regard. A wide array of diagnostic tests are used to determine the precise treatment required, the goal of which is to provide comfortable vision, normal head position, and normal human appearance. In some cases nonsurgical techniques can be used to treat strabismus, but there is no evidence that visual training is an effective means of straightening eyes in those cases where surgery is considered the treatment of choice. For the most common strabismus, essential infantile or "congenital" esotropia, 80+% of infants have "straight" eyes after the initial operation, and 90% after a second operation, most of these with "straight eyes" have residual deviation of 5 prism diopters of esotropia or less. More than 50% of surgically treated patients have stable, long-term satisfactory results. Considering the effort required on the part of the ophthalmologist, together with the physical and psychological benefit to the patient, the cost of strabismus surgery should be equal to that of any major ophthalmic surgical procedure. That strabismus surgery is compensated at a lower rate, than for example, cataract surgery, suggests that strabismus surgery is an excellent value.