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• W2130687221 abstract "In their article about intentional extreme anisometropia,1 Osher et al. make the appalling recommendation that patients with strabismus who are experiencing diplopia should not be given the opportunity to have corrective strabismus surgery. Instead, they recommend a procedure that will blur 1 eye and permanently diminish the prospect of ever restoring normal binocular vision. The authors make a number of misguided assertions in their discussion. They state that it is not desirable to perform “an additional operation” to correct strabismus. If the concern is to reduce the number of operations, then the second cataract surgery should not be performed in the first place, leaving the patient functionally monocular when the cataract progresses. They also state that “the outcome [of strabismus surgery] may be less successful in patients with noncomitant alignment.” Strabismus, including incomitant strabismus, is readily correctable in adults with a high degree of success.2,3 Finally, they state that “with the conventional approach, both eyes are targeted for distance and the patient depends on spectacles for near vision.” How likely is it that a fully informed individual with potential for binocular vision would surrender binocularity to avoid the inconvenience of reading glasses? The authors failed to provide the angle of strabismus in their patients, yet the angle is important to consider, as strabismus has both functional and psychosocial consequences. People of any age will benefit from the improved eye contact that results from reconstructive strabismus surgery. Again, patients need to be informed that they are giving up on restoring normal social interactions if they opt for this shortcut to eliminate diplopia. My biggest concern is that it is not clear from the article whether patients were adequately informed of the option of strabismus surgery before being treated with a procedure that abandons hope for restoring binocular vision. Most of the patients had never had strabismus surgery before the cataract procedure. Did every patient have a consultation with a strabismus surgeon? Did that specialist determine that it would be highly unlikely that corrective surgery would eliminate diplopia? Did the strabismus expert (rather than the cataract surgeon) give the patient a full account of the risks and benefits of strabismus surgery? Were patients told beforehand that they were surrendering binocular vision in order to avoid an extra procedure and the inconvenience of reading glasses? In conclusion, the majority of people who have both diplopia and cataracts will benefit from a coordinated effort wherein both cataract surgery and strabismus surgery are performed to restore full function, with excellent visual acuity in each eye and high-grade stereopsis. The procedure proposed by Osher et al. should be used only as a last-resort effort to treat patients with intractable diplopia resulting from, for example, retinal disease.4 “Intentional extreme anisometropic pseudophakic monovision” should be considered a desperate measure that is pursued only after consultation with an experienced adult strabismus specialist." @default.
• W2130687221 created "2016-06-24" @default.
• W2130687221 creator A5026161368 @default.
• W2130687221 date "2013-02-01" @default.
• W2130687221 modified "2023-09-27" @default.
• W2130687221 title "Intentional extreme anisometropic pseudophakic monovision" @default.
• W2130687221 cites W2056104150 @default.
• W2130687221 cites W2058331736 @default.
• W2130687221 doi "https://doi.org/10.1016/j.jcrs.2012.12.019" @default.
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