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Psychosocial impacts of adult strabismus and strabismus surgery: a review of the literature

Published:November 08, 2016DOI:https://doi.org/10.1016/j.jcjo.2016.08.013

      Abstract

      Background

      Patients with strabismus may suffer from both reduced visual functioning and the psychosocial effects of ocular misalignment. For adults with strabismus, there is a strong body of evidence supporting the advantages of surgical restoration of binocular visual function. However, even in the absence of binocular visual potential, patients may benefit from reconstructive surgery to restore an aesthetically acceptable ocular alignment.

      Objective

      To review the psychosocial implications of strabismus in the adult population and to summarize the psychosocial impact of surgical correction.

      Methods

      A Medline search (1946–2013) was conducted to identify the psychosocial implications of strabismus, its effects on employment, and the impact of surgical correction on strabismic adults using the following keywords: strabismus, surgery, quality of life, life style, employment/employability effects, job satisfaction, social support/social isolation/social marginalization, adaptation, stress, depression, family relations, interpersonal relations, friends, and peer group. The search was limited to patients older than 18 years and studies published in English. Of the initial 87 articles for which abstracts were reviewed, 20 studies were of sufficient relevance to be included in the review.

      Results

      Eight studies examined the psychosocial impact of strabismus, 2 of which explored the effect of strabismus on finding partners, and 4 studies examined the effect of strabismus on employment. These studies examined perceptions of both patients with strabismus and the general population. Eight studies evaluated the impact of strabismus surgery. Strabismus was shown to have negative psychosocial functioning and employability in both patients’ and the public’s perceptions. Surgical correction was associated with long-lasting improvement in psychological and social functioning.

      Conclusions

      There is a fairly strong body of evidence in the literature to suggest that adult strabismus patients suffer significant social, psychological, and economic effects because of their condition. Surgery can be effective in improving these disadvantages. Clinicians should be aware of the importance of offering surgery to patients with significant strabismus, even in patients for whom it is not expected to improve visual function.

      Résumé

      Objectif

      Examiner les répercussions psychosociales du strabisme au sein d'une population adulte et résumer les effets psychosociaux d'une correction chirurgicale.

      Méthodes

      Une recherche sur Medline (1946–2013) a permis de recenser les répercussions psychosociales du strabisme, ses effets sur le travail et les conséquences d'une correction chirurgicale chez des adultes. La recherche se limitait aux sujets d'au moins 18 ans et aux études publiées en anglais. Sur les 87 articles dont les résumés ont été passés en revue, on a retenu 20 études qui étaient assez pertinentes pour faire partie de notre revue de synthèse.

      Résultats

      Huit études portaient sur les répercussions psychosociales du strabisme, dont 2 études qui examinaient l'effet du strabisme sur la recherche d'un partenaire de vie et 4 études qui traitaient de l'effet du strabisme sur le travail. Ces études ont exploré les perceptions des sujets qui présentent un strabisme et celle de la population générale. Enfin, 8 études ont évalué l'effet d'une correction chirurgicale du strabisme. On a constaté que la perception du strabisme était négative quant au fonctionnement psychosocial et à l'employabilité, tant du point de vue des patients que de celui du grand public. La correction chirurgicale s'accompagnait d'une amélioration durable du fonctionnement psychologique et social.

      Conclusions

      L'ensemble de la preuve dans la littérature médicale est suffisamment robuste pour constater que les adultes qui présentent un strabisme vivent des effets sociaux, psychologiques et économiques importants en lien avec leur état. La correction chirurgicale peut contrer efficacement ces désavantages. Les médecins doivent être conscients de l'importance d'offrir une correction chirurgicale aux patients qui présentent un strabisme important, même dans les cas où l'on ne s'attend pas à une amélioration de la fonction visuelle.
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