The changing face of adult strabismus surgery

Introduction: Adult strabismus surgery rates increased by 24% in the
UK from 2000-2014. This study aims to highlight changes in the subtypes of strabismus being operated on over the past decade.
Methods: Retrospective case study. All adults receiving strabismus
surgery from 2008-2017 were included. All patients were operated
on by one attending surgeon. Case notes were examined for demographic, diagnostic and operative data.
Results: A total of 492 operations were performed on 466 patients,
with an average year-on-year increase in total number of adult strabismus operations of 16% over 10 years. Consecutive or residual
strabismus remained the most common subtype throughout the study
period and showed increasing rates as a percentage of all operations. Operative rates proportionately decreased for all other subtypes, except for those with esotropia or exotropia associated with
myopia.
Discussion: Although the mainstay of adult strabismus surgery remains consecutive or residual strabismus, a new subtype emerged
over the study period. That myopia is associated with late-onset esotropia (with lateral rectus weakness) is well known. We identified a
subgroup of myopic patients presenting in early adulthood with a decompensating esophoria and diplopia. These patients responded
well to surgery and now comprise a significant proportion of our
operative workload. The authors hypothesise that use of smartphones and associated sustained convergence are partially responsible for this subgroup.
Conclusions: More research is needed into the effect of sustained
convergence on those with myopia and esophoria. The nature of
strabismus surgery is changing, which has implications for training
and workforce planning.