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December 1996

Is Alignment Within 8 Prism Diopters of Orthotropia a Successful Outcome for Infantile Esotropia Surgery?

Author Affiliations

Wilkes-Barre, Pa
Iowa City, Iowa

Arch Ophthalmol. 1996;114(12):1530. doi:10.1001/archopht.1996.01100140728020

We congratulate Drs Kushner and Fisher on their excellent article in the February 1996 issue of the Archives.1 As the Outcomes Committee of the American Association for Pediatric Ophthalmology and Strabismus grapples with defining outcomes in pediatric ophthalmology, their article will certainly be valuable in helping to mold appropriate outcome definitions. They clearly show that the 6-month postoperative motor alignment of orthotropia or small-angle esotropia yields better long-term stability than small-angle exotropia. We also found that infantile esotropes with exotropia early after being operated on were more likely to drift outside 0±8 prism diopters than patients with orthophoria or esotropia.2

However, the alignment outcome should be considered only an intermediate outcome.3 It is the means to an end—the end being the sensory result that accrues from the change in ocular alignment. It is the sensory result that is the true health outcome (defined as that which affects