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Strabismus: aligning the doctor's vision with the patient's need
  1. David Bruce Granet
  1. Correspondence to Dr David Bruce Granet, University of California San Diego, San Diego, 9415 Campus Point Drive, La Jolla, CA 92037, USA; dgranet{at}ucsd.edu

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In the mid 1980s, on the American TV show, ‘Saturday Night Live’ Billy Crystal's Fernando character (based upon Fernando Lamas) developed the catchphrase ‘It is better to look good than to feel good.’ Is that true when it comes to strabismus? Is the looking good (appearing orthophoric) equally, or even more, important as feeling good (functional improvement)?

We know that correcting adult strabismus can improve stereo acuity/binocular vision, ocular motility and visual field.1–7 Patients often report improved self-esteem,8–10 communication skills,9 job opportunities,11 12 reading and driving.13 14 If we only think of strabismus surgery as eliminating diplopia (or visual confusion), restoring or creating binocularity, expanding visual field or eliminating a head posture, we leave out the equally as important psychosocial impacts.

Terminology is important, for it reflects and alters the way we approach and think about an issue. What nomenclature is used for improvement in appearance? Rosenbaum and Kraft have both pointed out that the term cosmetic is misapplied to the correction of strabismus.15–19 Cosmetic surgery should be thought of as being performed to enhance normal appearance. However, there is only one normal appearance of the eyes—orthophoria. Thus, intervention to align non-straight eyes is better termed reconstructive or restorative. The correction of a disfiguring problem can impact indicators of disability and improve personal self esteem.20 Outside self reflection, the …

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