The psychosocial aspects of strabismus in teenagers and adults and the impact of surgical correction.

PURPOSE: To evaluate the effect of surgical correction of strabismus on psychosocial parameters in teenagers and adults with a history of childhood-onset strabismus. METHODS: Consecutive patients older than 15 years of age who underwent strabismus surgery between 1997 and 2002 were contacted to complete a telephone questionnaire about their preoperative and postoperative psychosocial experiences. Formulas using the questionnaire answers were calculated to estimate the impact of strabismus on self-esteem, self-confidence, self-assessment of intelligence, effect on employment options, and interpersonal relationships preoperatively and to calculate the change in these parameters postoperatively. RESULTS: One hundred twenty-eight patients were identified with childhood-onset strabismus. Eighty-six percent (110/128) of patients reported that the strabismus caused them embarrassment preoperatively. These patients also reported trouble making eye contact (114/128) and developing mannerisms to camouflage their strabismus (96/128). The calculated preoperative self-esteem, self-confidence, and perceived intelligence scores were significantly improved following strabismus surgery. CONCLUSIONS: Strabismus surgery to restore ocular alignment has a significant effect on patients' self-esteem and self-confidence in patients with childhood-onset strabismus.

Optic-nerve gliomas, chiasmal gliomas and neurofibromatosis type 1.

PURPOSE OF REVIEW: To review the most recent literature describing the natural history and disease progression patterns of optic-pathway gliomas in neurofibromatosis type 1 (NF1) patients. To aid in clarifying the current treatment patterns and follow-up recommendations. RECENT FINDINGS: Contrary to prior documentation, current literature reveals that optic-pathway gliomas in NF1 can be diagnosed after the age of 6, and may progress until the age of 12. The disease progression occurs most frequently in the first two years following diagnosis. SUMMARY: Optic-pathway gliomas in NF1 can display a variety of manifestations and exhibit an unpredictable disease course. No specific characteristics have been found thus far to predict an aggressive compared with indolent disease course. Recently primary diagnoses of optic-pathway gliomas have been made in children aged six or older, and have been shown to progress until the age of 12. Although large-scale studies are required to change current follow-up recommendations, the data suggest that NF1 patients should be vigilantly evaluated for optic-pathway gliomas past the age of 12.