The use of the adjustable suture strabismus technique has led to a revolution in strabismus surgery. Previously, depending on the surgeon's experience, the results of strabismus surgery may not have been very predictable after a first eye muscle procedure, let alone subsequent ones. The advent of adjustable sutures permitted ophthalmologists to adopt new attitudes towards their patients. Firstly, non-experienced ophthalmologists could attempt surgery, knowing that if their approach were not quite right, they would be given a second chance during the postoperative adjustment process. Secondly, experienced strabismus surgeons could realistically foretell a successful outcome rate often exceeding 90%—a prediction practically impossible without the use of adjustable sutures.

As with any innovative procedure, surgeons then attempted to improve the technique. The paper in this issue of theBJO (p 80) by Choi and colleagues is such a potential improvement. Their premise is that the further in time from the actual strabismus surgery the adjustable process is performed, the higher the success rate should be. …