Strabismus: Surgery, Treatment, and Insurance Coverage

Q: Strabismus: Surgery, Treatment, and Insurance Coverage

Hello： (1) The angle of strabismus and surgical recommendations： Physicians typically decide whether to perform surgery based on the degree, type of strabismus, and the individual circumstances of the patient. <br>Generally, if the strabismus angle exceeds 15 to 20 prism diopters

Strabismus issues?

Hello, I would like to inquire about strabismus-related issues! I was diagnosed with esotropia in the second year of junior high school and was referred to National Taiwan University Hospital for further evaluation.
After a series of examinations, no underlying cause for the strabismus was identified.
Since I was a minor at the time, my parents only took me to get prism glasses.
Recently, I would like to address this issue.

(1) What is the typical angle of strabismus that would prompt a physician to recommend surgery? Is it true that the smaller the angle, the easier it is to achieve successful correction through surgery?
(2) Does the angle of strabismus tend to increase with age?
(3) Is the surgery covered by health insurance? I have seen information stating that insurance coverage is available only if the corrected vision in both eyes is less than 0.8.

Xiao Bai, 20~29 year old female. Ask Date: 2024/06/24

Dr. Gao Pilin reply Ophthalmology

Hello: (1) The angle of strabismus and surgical recommendations: Physicians typically decide whether to perform surgery based on the degree, type of strabismus, and the individual circumstances of the patient.
Generally, if the strabismus angle exceeds 15 to 20 prism diopters (PD), the physician will consider surgical treatment.
The success rate of surgery does not solely depend on the magnitude of the angle; more importantly, it relies on a comprehensive preoperative assessment and postoperative rehabilitation.
Surgery for smaller angles of strabismus may be relatively easier, but each patient's situation is different and requires the judgment of a specialized ophthalmologist.
(2) The angle of strabismus and age: The angle of strabismus may change with age; some individuals may experience a gradual increase in the angle, while others may remain stable or only show slight changes.
This depends on the type of strabismus, the presence of other ocular or systemic diseases, and the development of the ocular muscles.
Therefore, regular ophthalmic examinations are crucial for early detection and management of issues.
(3) Surgical insurance coverage: There is no regulation stating that strabismus surgery is covered by insurance only if "the corrected vision in both eyes is less than 0.8." Instead, surgery to correct poorly visioned eyes is primarily for cosmetic reasons and may require out-of-pocket expenses.
For more accurate details, please consult the surgeon.

Reply Date: 2024/06/24

More Info

Strabismus, commonly known as squint or crossed eyes, is a condition where the eyes do not properly align with each other when looking at an object. It can lead to various visual problems, including double vision and amblyopia (lazy eye). Understanding strabismus involves recognizing its causes, treatment options, and the implications of surgery, including insurance coverage.

1. Surgical Indications: The decision to recommend surgery for strabismus typically depends on the angle of deviation. Generally, if the strabismus angle is greater than 15-20 prism diopters, surgery may be considered. However, the exact threshold can vary based on individual circumstances, including the type of strabismus (e.g., esotropia or exotropia) and the patient's age. It's important to note that while larger angles may indicate a more significant misalignment, smaller angles can also be surgically corrected, especially if they cause functional problems or cosmetic concerns. The success of surgery does not solely depend on the angle; factors such as muscle strength, the presence of amblyopia, and the patient's overall eye health also play crucial roles.

2. Age and Strabismus: As individuals age, the angle of strabismus can change. In some cases, the angle may increase due to changes in muscle tone or the development of other ocular conditions. However, in many patients, especially those with congenital strabismus, the angle may remain stable over time. Regular follow-ups with an ophthalmologist are essential to monitor any changes in the condition and to determine the best timing for potential surgical intervention.

3. Insurance Coverage: In the United States, insurance coverage for strabismus surgery can vary significantly. Generally, if the strabismus is causing significant visual impairment or if the cosmetic appearance is a concern, surgery may be covered. The criteria for coverage often include having a certain degree of misalignment and the presence of amblyopia or other visual deficits. The information you mentioned about needing a visual acuity of less than 0.8 (20/25) in both eyes for insurance coverage is a common guideline, but it is essential to check with your specific insurance provider for their policies. Additionally, a thorough evaluation by an ophthalmologist can help establish the medical necessity for surgery, which is crucial for insurance approval.

In summary, strabismus is a complex condition that requires careful evaluation and management. If you are considering surgery, it is advisable to consult with a pediatric ophthalmologist or a specialist in strabismus. They can provide a comprehensive assessment of your condition, discuss the potential benefits and risks of surgery, and guide you through the insurance process. Early intervention can lead to better outcomes, so addressing your concerns sooner rather than later is beneficial.

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