Surgery Improves Quality-of-Life for Patients with Cyclodeviation

Strabismus, Surgery (Photo By BSIP/UIG Via Getty Images)
Researchers used quality of life questionnaires to evaluate the impact of both living with cyclodeviation and undergoing correctional procedures.

Adult patients with cyclodeviations experience a significantly reduced quality of life, according to findings in the Journal of American Association for Pediatric Ophthalmology and Strabismus. 

However, researchers identified that patients who underwent strabismus surgery scored higher on a health-related quality of life (HRQoL) questionnaire than they did preoperatively (P =.002). On the Adult Strabismus-20 (AS-20) evaluation, postoperative patients showed a significant improvement in the functional subscale score (P =.001), but not in the psychosocial subscale score (P =.23), suggesting that strabismus leads to QoL consequences that are largely psychosocial, according to the research.

From 2014 to 2019, the study followed a cohort of 29 adult patients with a mean age of 56 years who have cyclodeviation and cyclodiplopia and were planning to undergo corrective strabismus surgery. Preoperative scores on the AS-20 questionnaire were compared with those of control patients, who scored higher overall on the evaluations. In total, 61 adults participated in the study.

The study explains, “The patients with cyclodeviation were divided into 2 groups, depending on which type of surgery they required in order to regain cyclofusion: the Harada-Ito group, requiring a correction/reduction of cyclodeviation by the Harada-Ito procedure; and the vertical group, requiring only correction of vertical deviation.”

Researchers say they know that surgery for strabismus improves levels of social anxiety, because these patients lose control of the eye during interactions. However, cyclodeviation is not externally visible, despite causing visual disturbance. The study was conducted to compare the HRQoL scores of patients with strabismus with those of nonstrabismic subjects.

Among the patients who received surgery, there was a significant improvement in the mean postoperative scores (69.9 out of 100) as compared with those preoperatively (59.9); however, the mean score for control patients was significantly higher (96.8).

The Harada-Ito subgroup showed a larger difference in quality of life before and after surgery (P =.024) than the vertical group, suggesting that vertical or horizontal diplopia is not as disabling for patients as torsional diplopia, which the first group experiences. Regarding the questionnaire subscales, the Harada-Ito group had a significant improvement (P =.013) for the functional portion, but not the psychosocial portion, while the changes in the vertical group were not significant.

“The main change in scores, and hence improvement in quality of life, was observed in the functional subscale,” the study determines. “This implies that the ocular misalignment of the patients in this study was not noticeable to most observers and was also not the main concern of the patient.”


Flodin S, Rydberg A, Pansell T, Grönlund MA, Measuring health-related quality of life in individuals with cyclodeviation using the Adult Strabismus 20 (AS-20) questionnaire. J AAPOS. Published online December 14, 2020.  doi: 10.1016/j.jaapos.2020.08.011.