Most ophthalmologists have experienced rejection by an insurance company for requesting surgical correction in an adult patient with strabismus on the grounds that the surgery is "cosmetic." I now have had experience with an insurance company that requested strabismus photographs for surgical authorization even in adults with acquired strabismus from thyroid myopathy and cranial nerve palsies (III, IV, and VI) for example.
There are now three major reasons to correct adult strabismus: (1) restoration of binocular fusion and elimination of diplopia, (2) expansion of binocular visual fields in patients with esotropia,1 and (3) improvement in psychosocial functioning.2
RESTORATION OF BINOCULAR FUSION AND ELIMINATION OF DIPLOPIA
The combined restoration of binocular fusion and elimination of diplopia is already accepted as a reason to correct strabismus in adults. There also is evidence that early surgery for correction of congenital esotropia improves infant development.3 Rogers et al3 reported an
Keltner JL. Strabismus Surgery in Adults: Functional and Psychosocial Implications. Arch Ophthalmol. 1994;112(5):599–600. doi:10.1001/archopht.1994.01090170043019
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