Other causes that may play a role include “sleep apnea, changes in diet, and lifestyle comorbidities associated with the use of electronics,” said Federico G. Velez, MD, at Duke University in Durham, North Carolina. “Studies based on magnetic resonance imaging of the extraocular muscles have given us important information on the anatomy of the muscles and how we can make surgery more effective.” (See “A Look at MISS.”). This patient developed Graves disease as an adult. His field of single vision was looking down to the left” (Fig. I have personally operated on patients in their 90's, and they were delighted with the results. Over time, that eye had deviated significantly.” The patient had been told that, as she was blind in that eye, surgery was not indicated. An incision is made in the clear membrane (called the conjunctiva) lining the white part of the eye, the muscle is separated, and then it’s reattached with dissolvable sutures. The average rating was 0.85. Dr. Dagi also noted that she is seeing “increasing numbers of adults with lifelong strabismus for whom prior surgery failed over time.” Many of these patients were told, incorrectly, that if the surgery did not work before, it would not work now—or that they would develop diplopia if they underwent surgery as adults. This cost model included initial consultation fee, surgeon's fee, facility fee, anesthesia fee, postoperative drug costs and average complication costs. “The patient was diagnosed with distance esotropia divergence insufficiency, consistent with sagging-eye syndrome,” Dr. Velez said. If you’re seeing an uptick in the number of adult patients with strabismus, you’re not alone. A 61-year-old woman presented to Dr. Velez and his fellow, Megan Law, MD, with a history of progressive, constant horizontal distance diplopia. Few weeks: The white part of your eyes may be red for several weeks, however your … Excision of scarring between the extraocular muscles and the implant, and adjustable suture surgery on the patient’s superior oblique, lateral rectus, and inferior rectus muscles restored a wide field of binocular single vision, (Fig. "In the United States, treatments with an associated incremental cost-utility of less than $50,000 per QALY are generally considered 'very cost-effective,'" they said. “At his last post-op follow-up, he was diplopia free, the motility examination revealed orthotropia in primary and secondary gaze positions, and his intraocular pressure remained stable with no medications.”. Although adult strabismus surgery has been shown to be highly cost-effective, many adults with strabismus can be successfully managed by non-surgical means. adult strabismus surgery recovery. Dr. Dagi is associate professor of ophthalmology at Harvard and director of the Adult Strabismus Program at Boston Children’s Hospital in Boston. They will return to work only with the approval of their primary care physician. We are rescheduling appointments if the screen reveals a risk of infection. Some cases—particularly divergence insufficiency, sagging-eye syndrome, and strabismus fixus—are associated with aging. Dagi, Pineles, and Velez provided the following case synopses to illustrate the challenges and rewards of the types of cases they treat. And as the population has aged, these conditions “have generated an increase in referrals for patients who would like definitive surgical repair of their new-onset diplopia,” said Linda R. Dagi, MD, at Harvard and Boston Children’s Hospital in Boston. How is Strabismus (Eye Muscle) Surgery Performed? He noticed diplopia one to two months following implantation,” he said. Also available at aao.org/ppp. In addition, she pointed out that “patients who have strabismus from thyroid eye disease are at risk of developing a very rare complication called pulled-in-two syndrome.” This is a spontaneous horizontal transection of an extraocular muscle about 10 mm back from the anatomical insertion—and while successful repair is nearly always possible, the surgeon should be experienced in operating with the abnormally stiff muscles associated with thyroid eye disease, Dr. Dagi said. A 47-year-old member asked: How long is the recovery from strabismus surgery? The patient’s diplopia and hypertropia resolved postoperatively, Dr. Velez said. We will do everything we can to keep you and your family safe rule, all patients over two years of age, and all accompanying adults are required to wear a mask in order to enter our offices. Before surgery, patients rated their expected improvement in quality of life, known as utility, as a numerical value from 0 to 1. . Ophthalmology. The superior oblique tendon was repositioned, and the superior rectus muscle was recessed. Third, we have newer techniques that are less invasive and can be done under topical anesthesia, making the surgery less daunting for many patients.”, According to the Academy’s recently published Adult Strabismus Preferred Practice Pattern, strabismus is common among adults, with an estimated incidence of 4%.1. Some cases—particularly divergence insufficiency, sagging-eye syndrome, and strabismus fixus—are associated with aging. 1. “She had stopped driving and playing tennis,” Dr. Velez said. Dr. Velez is associate professor of ophthalmology at Duke Eye Center, Duke University in Durham, N.C. Surgical correction of strabismus in adult patients appears to be cost-effective, resulting in a cost-utility of less than $2,000 per quality-adjusted life year, according to a recent financial analysis. “His past surgical history included right eye superior trabeculectomy with mitomycin C, multiple needling, and implantation of a superotemporal drainage device. Following adult strabismus surgery, patients can expect to take anti-infection eye drops and try to reduce swelling, according to Massachusetts Eye and Ear from the Harvard Medical School Teaching Hospital. Driving Factors. My concept refers to more selective, less invasive muscle procedures,” which may vary in size. “When addressing more complex cases in which there has been prior extraocular or orbital surgery and scarring, this approach may limit what can be accomplished,” Dr. Dagi said. I performed 6.5-mm MR resection and 10-mm LR recession. The surgery literally changed her personality and her life.”, Technically, the patient had 70 PD of exotropia, Dr. Pineles said. All patients will be taken into an exam room as quickly as possible. Since the patient was monocular, I had to operate only on one eye—despite the fact that I would typically do both eyes for this large of an angle. “Many of our adult strabismus patients have other medical comorbidities, and some take anticoagulants, so close consultation with other treating physicians is important at all points during their care,” Dr. Dagi said.