Correlation of Strabismus Surgical Outcomes Graded by Goal-Determined Metric With Patient Satisfaction Survey

center dot PURPOSE: Although 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. center dot DESIGN: Validity analysis comparing a clinical "goaldetermined metric" to patient satisfaction. center dot METHODS: Goal -determined metric outcomes (20182021) for 2 surgeons treating esotropia or exotropia for diplopia control or reconstructive goals were collected. Inclusion required completion of postoperative examination 2-6 months after surgery and a satisfaction survey. center dot RESULTS: Record review identified 275 patients; 228 (median age 41 years [interquartile range 13-591) 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% to 79% for all reconstructive surgery and for treatment of diplopia from esotropia. Agreement was lower, although not statistically different, for treatment of diplopia from exotropia (64%, 95% CI 43%-80%; P = .184). Preoperative 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 = .004). For reconstructive cases achieving "much better" eye alignment, 62% and 72% (previously esotropic and exotropic) reported enhanced self-confidence. center dot 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. (Am J Ophthalmol 2024;260: 140-146. (c) 2023 Elsevier Inc. All rights reserved.)