title: Goal-determined metrics to assess outcomes of esotropia surgery.
abstract: OBJECTIVE
  To report outcomes of esotropia surgery with a goal-determined tool.
  
  
  METHODS
  A goal-determined outcomes analysis tool was devised to address a quality improvement initiative at Boston Children's Hospital. Surgeons preoperatively ranked four possible goals for intervention: enhancement of binocular potential, restoration of eye contact (reconstructive), management of diplopia, and resolution of torticollis. Criteria for success were goal specific; the primary outcome measure was surgical success at 2-4 months. Secondary outcomes included appraisal of risk factors and a comparison of outcomes with this methodology versus traditional criteria for success based on motor alignment. No patients were excluded based on diagnosis, systemic and ocular risk factors, or intervention performed.
  
  
  RESULTS
  A total of 824 patients underwent esotropia surgery from 2006 to 2012 and returned for evaluation at 2-4 months' follow-up. Of these, 777 had sufficient documentation for inclusion: 372 procedures were performed primarily to improve binocular potential; 238, to restore eye contact; 124, to resolve diplopia; and 43, to remediate torticollis. Excellent (71%) or good (13.7%) results were obtained in 84% of cases. Without associated risk factors, 75% had excellent and 14% had good outcomes. Risk factors were present in 444 (57%). Success diminished with prior strabismus surgery (P = 0.004), preoperative angle ≥50(Δ) (P = 0.002), and surgery before 12 months of age (P = 0.003). Patients having surgery to remediate diplopia had the best outcomes (excellent, 79%; good, 8%). Preoperative ranking of goals allowed demonstration of better results than would have been reported with requirement of "traditional" motor alignment criteria (P = 0.009).
  
  
  CONCLUSIONS
  Goal-determined methodology can be useful for monitoring outcomes of esotropia surgery in diverse populations.
authors.affiliation: Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Miriam
authors.initials: M
authors.lastname: Ehrenberg
authors.affiliation: Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Bharti R
authors.initials: BR
authors.lastname: Nihalani
authors.affiliation: Program for Patient Safety &Quality, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Patrice
authors.initials: P
authors.lastname: Melvin
authors.affiliation: Program for Patient Safety &Quality, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Christina E
authors.initials: CE
authors.lastname: Cain
authors.affiliation: Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: David G
authors.initials: DG
authors.lastname: Hunter
authors.affiliation: Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: linda.dagi@childrens.harvard.edu.
authors.forename: Linda R
authors.initials: LR
authors.lastname: Dagi
mesh_terms: D002648:Child; D002675:Child, Preschool; D004172:Diplopia / Q000503:physiopathology; D004948:Esotropia / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006040:Goals; D006801:Humans; D007223:Infant; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000592:standards*; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology