Date Published:
2023 Dec 15
Abstract:
PURPOSE: While strabismus surgery outcomes can be objectively measured, patient perception of results may differ. We present surgical outcomes graded by a prospective, "goal-determined metric" and compare these outcomes to results of a patient satisfaction survey. DESIGN: Validity analysis comparing a clinical "goal-determined metric" to patient satisfaction METHODS: Goal-determined metric outcomes (2018-2021) for two surgeons treating esotropia or exotropia for diplopia control or reconstructive goals were collected. Inclusion required complete post-operative examination 2-6 months after surgery and a satisfaction survey. RESULTS: Record review identified 275 patients; 228 (median age 41 years (IQR 13-59)) met inclusion criteria. For the entire cohort, 87% were graded as "excellent" outcomes, and 78% of patients were overall "very satisfied". Agreement between patients' and surgeons' grading was 75-79% for all reconstructive surgery and for treatment of diplopia from esotropia. Agreement was lower, though not statistically different, for treatment of diplopia from exotropia (64%; 95% CI 43-80%) (P=0.184). Pre-operative risk factors, concurrent vertical or oblique surgery, and sex did not affect outcomes or satisfaction. Performance of activities requiring distance viewing improved more than performance of activities at near after esotropia-diplopia surgery (odds ratio 3.0 (95% CI: 1.5-6.4, P=0.004)). For reconstructive cases achieving "much better" eye alignment, 62% and 72% (previously esotropic and exotropic) reported enhanced self-confidence. CONCLUSIONS: Outcomes graded by goal-determined metric correlated well with many aspects of patient satisfaction. Patient-perceived improvement in appearance was important regardless of goal. Greater improvement in performance of activities requiring distance rather than near viewing characterized treatment of diplopia from esotropia.
