​​Early Strabismus Surgery Does Not Interfere with Amblyopia Management

In this study, pediatric and adolescent patients with strabismus and amblyopia from the IRIS registry experienced an average improvement of 1.7 lines in VA within two years following an amblyopia diagnosis. Photo: B. Navez/Wikicommons. Click image to enlarge. There are no established guidelines on the timing or benefit of strabismus surgery in the setting of strabismic amblyopia. Traditional recommendations advise full treatment of amblyopia to restore normal vision before proceeding with surgery. Researchers primarily based in Memphis decided to use the large patient volume in the IRIS (Intelligent Research in Sight) Registry to evaluate whether children with strabismic amblyopia achieve better visual outcomes when surgery is performed and if earlier surgery provides additional visual benefits. Their findings challenge concerns that early surgery might hinder amblyopia management, as their data did not support this. Strabismus surgery did not negatively or positively impact visual outcomes in strabismic amblyopia. Improvement was most pronounced in the youngest group (ages three to seven years), and patients, up to at least age 12, may still have visual benefits from both strabismus surgery and amblyopia treatment.“While we do not advocate performing strabismus surgery on patients with amblyopia without first attempting amblyopia treatment, we believe that surgery should not be indefinitely delayed,” they wrote in their paper, which was published in Ophthalmology.The study assessed visual acuity (VA) at six, 12 and 24 months post-amblyopia diagnosis. Patients were categorized based on age (three to seven, eight to 12 or 13 to 17) and whether they had strabismus surgery before or within six months of amblyopia diagnosis. Of the 21,242 patients analyzed, 1,703 (about 8%) underwent surgery within six months of amblyopia diagnosis, and 19,539 did not.Among patients with baseline VA worse than 20/30, visual acuity significantly improved over time in both the surgery and no surgery groups. Overall, VA improved from 0.46 logMAR at baseline to 0.29 logMAR at 24 months, with significant improvements observed in both groups at each follow-up (six, 12 and 24 months). Patients who had strabismus surgery either before or within six months of diagnosis showed similar visual outcomes (for up to two years of follow-up) to those who had surgery after six months or did not have surgery at all. Strabismus surgery was not associated with a higher chance of amblyopia treatment success in any age group in the multivariate analysis.“Our findings did not indicate added benefit from strabismus surgery, in terms of VA improvement,” the researchers commented in their paper. “It should be noted that strabismus surgery could offer additional benefits beyond improving VA, such as enhancing quality of life and reducing the risk of physical injuries associated with misalignment.” The most significant VA improvement occurred in children ages three to seven, followed by those ages eight to 12 years, irrespective of surgery status. While the IRIS Registry does not specify whether or how amblyopia was treated, the researchers assumed that therapy was provided. They suggested that the decline in improvement with age was likely due to reduced neuroplasticity and poorer compliance among older children. Click here for the journal source.  Hoehn ME, Nabavi A, Rahdar, et al. Visual outcomes after strabismus surgery in pediatric patients with strabismic amblyopia: an IRIS Registry study. Ophthlamology. April 28, 2025. [Epub ahead of print].