INSURANCE COMPANIES and managed care providers continue to challenge the medical necessity and indications for many cases of adult strabismus surgery. The rationale of their medical reviewers is usually based on the idea that the only valid indications for strabismus surgery are to achieve fusion or to correct diplopia. They assume incorrectly that unless perfect (bifoveal) fusion can be obtained, there will be no improvement in fusion at all. Adults with residual or recurrent strabismus from childhood usually do not report diplopia. The general understanding in our profession is that bifoveal fusion cannot be achieved as an adult unless it was previously present in childhood. Thus, some claims for coverage for these types of cases are rejected. This continues despite continually expanding data on the efficacy of adult strabismus surgery, including a previous editorial in this journal.1
Rosenbaum AL. The Goal of Adult Strabismus Surgery Is Not Cosmetic. Arch Ophthalmol. 1999;117(2):250. doi:https://doi.org/10.1001/archopht.117.2.250
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