title: Goal-determined metrics to assess outcomes of exotropia surgery.
abstract: OBJECTIVE
  To present a goal-determined methodology for monitoring outcomes after surgery for exotropia.
  
  
  METHODS
  The goal-determined metric required surgeons to rank four possible goals preoperatively: (1) binocular potential, (2) restoration of eye contact, (3) diplopia control; and (4) torticollis management. Potential preoperative risk factors were noted. Goal-specific outcomes criteria were applied to the latest sensory-motor examination, 2-6 months after surgery. The medical records of patients who underwent surgery from 2007 to 2012 were retrospectively reviewed with respect to the goal-directed metric.
  
  
  RESULTS
  A total of 852 patients were evaluated in the study period: 411 for restoration of eye contact; 347 for binocular potential; 78 for diplopia resolution; and16 for torticollis management. Excellent (62%) or good (16%) outcomes were achieved in 78%. Procedures to resolve diplopia (OR, 6.56; 95% CI, 3.39-12.68) and to restore eye contact (OR, 3.74; 95% CI, 2.65-5.29) were more likely to result in excellent outcomes than procedures to improve binocular potential. Simultaneous surgery for dissociated vertical deviation (OR, 0.38; 95% CI, 0.16-0.92) and preoperative near deviation ≥50(Δ) (OR, 0.27; 95% CI, 0.17-0.42) limited likelihood of an excellent outcome. Outcomes monitored by simultaneous rather than alternate prism and cover test were more likely graded excellent (OR, 5.16; 95% CI, 3.50-7.62). Applying motor criteria from the binocular potential goal to the entire cohort diminished putative outcomes (P < 0.001).
  
  
  CONCLUSIONS
  Goal-determined metric monitoring outcomes of exotropia surgery provides outcomes germane to the reason for intervention, enables analysis of risk factors affecting outcomes, and facilitates reporting on heterogeneous populations.
authors.affiliation: Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Yoon-Hee
authors.initials: YH
authors.lastname: Chang
authors.affiliation: Program for Patient Safety & Quality, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Patrice
authors.initials: P
authors.lastname: Melvin
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; D003663:Decision Trees; D004172:Diplopia / Q000503:physiopathology; D005099:Exotropia / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006040:Goals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D014103:Torticollis / Q000503:physiopathology; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology