Factors associated with seeking delayed strabismus surgery
Reviewed by Fiona Rowe

The purpose of this study was to investigate the main reasons for delay in strabismus surgery and assess patients’ motivations to undergo strabismus surgery in adulthood. This was a prospective study in the Republic of Moldova of 91 patients with childhood concomitant strabismus. All had delayed surgery and were operated in 2017-2019. There were 58 females and 43 males with mean age of 24 years (range 16-58). Esotropia was present in 40 and exotropia in 51. Median age at strabismus detection was 3.3 years (IRQ 3-5). Seventeen were diagnosed at age 0-2 years, 52 at 3-5 years and 22 at 6-9 years. Nineteen had strabismus surgery with residual deviation. Median duration from last surgery to latest was 19.5 years (IQR 13-26). Median duration from detection to current surgery in those never having prior surgery was 21.2 (IQR 17-28.4). The most common reasons for delay included lack of awareness of surgery (n=34), specialist confirming surgery would not improve strabismus (n=25), fear of surgery (n=16), surgery declined by parents when the patient was still a child (n=6), previous poor surgical experience (n=6) and non-affordability (n=4). Similar reasons were given whether esotropia or exotropia. Main motivations for seeking strabismus surgery as adults included the wish to improve appearance (n=35), improve self-confidence (n=28), better social relationships / prospects (n=15), better job opportunities (n=7) and advice from family / friends (n=6). Patients aged 16-20 were more aware of appearance and self-confidence issues. For those aged 21-25, building better social relationships / prospects were most important. Differences in main reasons were seen for gender. Females wanted improvement of appearance more and males wanted improvement of self-confidence. The study was limited by its single centre study such that results may not be generalisable. The authors conclude a high (80%) delay of strabismus surgery due to lack of awareness by patients of surgical possibilities and misconception among clinicians that surgery may not be appropriate. Factors reported by patients highlight negative impact of strabismus on patient’s psychological status.

Causes of concomitant strabismus surgery delay in teenagers and adults.
Paduca A, Arnaut O, Lundmark PO, Bruenech JR.
STRABISMUS
2021;29(3):151-7.