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  • Pediatric Ophth/Strabismus

    Review of: Correlation of strabismus surgical outcomes graded by goal-determined metric with patient satisfaction survey

    Elhusseiny A, Agrawal S, Staffa S, et al. American Journal of Ophthalmology, April 2024

    Patients who underwent strabismus surgery for esotropia or exotropia reported surgical satisfaction levels that correlated well with pre-determined objective metrics for successful surgical outcomes.

    Study Design

    This was a retrospective review of data from 228 children and adults who underwent strabismus surgery between 2018 and 2021. The primary reason for surgery was either control of diplopia or reconstructive goals. Two to six months after surgery, a sensorimotor evaluation was performed, with results used to determine whether outcomes conformed to goal-determined metrics. At the same visit, patients or their caregivers were asked to complete a satisfaction survey.


    Overall, there was good agreement between objective strabismus improvement and subjective patient satisfaction. Patients undergoing surgery for reconstructive reasons showed high agreement between objective measurements and patient satisfaction (75%–89%). Esotropic patients with diplopia also showed high agreement (78%). While only 64% of exotropic patients with diplopia had agreement between objective findings and subjective patient satisfaction, this was not clinically significant.


    Although the survey was based on the Amblyopia Treatment Survey-20 questionnaire, it was not originally intended for research and thus had not been validated. Furthermore, the survey was only administered postoperatively. It was not clear at what point during the examination the survey was administered—before or after seeing the physician. If the survey was given after the patient had seen the surgeon, hearing what they think could have skewed patient perception.

    Clinical Significance

    Patients undergoing strabismus surgery for reconstructive or “cosmetic” reasons showed high satisfaction with results. Overall patient satisfaction after strabismus surgery agreed with objective alignment measurements, but reasons for surgery and type of strabismus may influence post-operative satisfaction.

    Financial Disclosures: Dr. Brenda Bohnsack discloses no financial relationships.