- Individuals with strabismus, particularly exotropic strabismus, were rated by dating agents as less likely to find a romantic
partner than individuals without visible facial anomalies. Strabismic subjects were also perceived to be less attractive,
erotic, sporty, intelligent, interesting, successful and likeable. Dr Daniel Mojon argues that correcting this condition is,
therefore, more than a cosmetic procedure, and has the potential to improve sufferers' quality of life as well as visual function.
Sufferers of strabismus are exposed to psychosocial as well as physical difficulties, and eye realignment can, far beyond
restoring visual function, have a profound impact on the lives and lifestyles of sufferers. Correcting this condition is,
therefore, much more than a cosmetic procedure.
Although the deleterious effect of strabismus on the ability to perform well educationally, find employment and secure career
progression has been noted in previous studies,1–4 and the relationship between strabismus and mental health problems has also been considered,5 the wider impact on sufferers' personal lives and fundamental human relationships and interactions remains undocumented.
The social burden of strabismus
"An abnormal face impacts on self-esteem and quality of life, leading to significant distress, which can be reversed with
corrective surgery,"6–11 stated Daniel S. Mojon, MD. "Strabismus definitely falls within this category — to the extent that the majority of strabismics
would relinquish a portion of their life expectancy in exchange for being rid of the condition and its effects12 — with several studies suggesting that there are greater impediments for esotropic strabismics when compared with exotropic
To widen our understanding of the impact of the condition, Dr Mojon and his colleagues conducted a study examining the impact
of both forms of strabismus and other facial anomalies on the perceived ability to find a romantic partner, the results of
which he discussed with Ophthalmology Times Europe.
Conducting the study
Dr Mojon's team conducted telephone interviews with the employees of 40 dating agencies in Switzerland, some of whom were
able to access digitally altered photographs of a male and female subject: Dr Mojon and his wife, Dr Mojon-Azzi. As well as
the original photographs, several of the images had been modified to display one of the following visible facial anomalies:
missing teeth, significant acne, scars and protruding features (ears and nose) as well as strabismus. To maintain consistency
with earlier studies, the strabismus angle corresponded to 50 prism dioptres in both exotropic and esotropic photographs.
"We used an already-validated questionnaire for the telephone interviews, similar to the questionnaire that we had used previously
to assess the employability of strabismic subjects as perceived by headhunters,"4 explained Dr Mojon, who ensured that all close-ended questions were unambiguous to obtain a clear, non-subjective, result.
Of the 40 dating agents interviewed, 23 were able to view the digitally-altered images via the internet, and the remainder
responded based on previous experience and perceptions, according to Dr Mojon.
"As well as general questions about perceived negative discrimination, we also asked the dating agents to rate how well they
perceived people with the facial anomalies for each of the following characteristics: reliability, honesty, fidelity, likeability,
being interesting, success, intelligence, attractiveness, sporting ability and eroticism," continued Dr Mojon. "We concluded
by asking the dating agents how they thought the various types of facial anomalies would influence partner-finding ability."
What do the dating agents think?
When comparing strabismic with orthotropic individuals, 92.5% believed that strabismus would have a negative impact on ability
to find a partner; 7.5% stated that the effect would be negligible, and no respondents thought that the condition would be
beneficial in securing a romantic partner.
Although the existence of strabismus was overwhelmingly perceived to be negative, the dating agents were divided as to whether
the age or gender of the strabismic subject would have an impact; the general consensus was that these factors were not statistically
significant. However, contrary to previous study findings, exotropia was deemed to have the more significant negative impact
when compared with esotropia: 20 dating agents thought that exotropia would have the stronger negative impact, whereas only
four believed esotropia would be less appealing.
"This was a particularly interesting result; we think it may be explained by the fact that people value personality traits
in a potential romantic partner differently than they do those of a potential colleague," suggested Dr Mojon. "For example,
attractiveness was not found to impact significantly on employers' assessments of potential employees, whereas this was, of
course, an important consideration for the dating agents."
How does strabismus compare?
Although strabismus was not found to be the facial anomaly with the biggest impact — both significant acne and visible missing
teeth rated higher (Table 1) — the contrast between the dating agents' reaction to these images and to the unaltered images was significant. Protuding
features and facial scarring were perceived to have less impact on potential partners than either exotropic or esotropic strabismus.
The perception of strabismus sufferers' personality traits was also negative when compared with those of orthotropic subjects:
strabismics were perceived as less attractive, erotic, likeable, interesting, sporty and successful than orthotropic subjects
Table 1: Impact of seven facial disfigurements on the ability to find a partner: dating agents opinion
"I must stress, these results were based on the agents' perceptions and not on their actual experience, and we did not question
strabismics themselves," cautioned Dr Mojon. "Nevertheless, the a priori results we obtained demonstrated significant prejudice against strabismus sufferers as potential romantic partners. This,
combined with the poor self-esteem experienced by many sufferers of the condition, illustrates how acutely the condition affects
every aspect of strabismics' lives."
Table 2: Influence of strabismus on potential partners perceptions of personality traits*
The negative effects are undeniable
As in earlier studies, these results demonstrate that the impact of strabismus is greater than compromised visual function.
The psychosocial distress and negative discrimination experienced by sufferers of the condition has the potential to impact
quality of life, in some cases severely. Altering the appearance is important, but is nevertheless not the sole goal of strabismus
"Surgery for this condition — as it restores visual function to what is normal for humans, in addition to providing aesthetic
enhancements and eliminating the distress caused by the condition — should never be categorized as cosmetic," said Dr Mojon.
"Nevertheless, because of the perception that strabismus correction is somehow frivolous and is conducted for purely cosmetic
purposes, its necessity is often challenged by health insurance and managed care providers. I believe this is motivated primarily
by increasing healthcare costs, but I also believe that denying reimbursement for this surgery is a mistake, not least because
it has been shown to be more cost-effective than cataract surgery, diabetic pars plana vitrectomy for vitreous haemorrhage
or amblyopia therapy."12
The negative effects of strabismus are undeniable. Because strabismus correction can improve visual function as well as contributing
to the attainment of major life goals — securing a relationship and employment — and being highly cost-effective, Dr Mojon
believes that the surgery should not be restricted, as it is not solely a cosmetic procedure.
Daniel S. Mojon, MD works at the Department of Strabismology and Neuro-Ophthalmology at Kantonsspital St Gallen, Bern, Switzerland. He may be
reached by Email: firstname.lastname@example.org
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