What are the medical decision making strategies for strabismus (dystopia)?

From the Guidelines

The most effective medical decision-making strategy for strabismus (dystopia) involves a comprehensive approach that includes counseling the patient on diagnosis and treatment options, providing goal-directed management to restore binocularity and control of diplopia, and communicating with other healthcare providers about the diagnosis and treatment plan. This approach is supported by the most recent and highest quality study, which emphasizes the importance of patient-centered care and individualized treatment plans 1.

Key Components of Medical Decision Making

• Counseling the patient on diagnosis and treatment options to ensure informed decision-making
• Providing goal-directed management to restore binocularity and control of diplopia, which may include surgical or non-surgical interventions
• Communicating with other healthcare providers about the diagnosis and treatment plan to ensure coordinated care

Considerations for Treatment

• The goal of treatment should be to improve functional visual status, address psychosocial concerns, and restore normal ocular alignment 1
• Treatment options should be individualized based on the patient's specific needs and goals, and may include surgery, prism correction, or other interventions
• The potential benefits of strabismus surgery include improvement in binocularity, reduction of diplopia or compensatory head posture, and improvement in psychosocial function 1

Importance of Patient-Centered Care

• Patient-centered care is essential in the management of strabismus, as it allows for individualized treatment plans and improved patient outcomes 1
• Patients should be counseled on the potential benefits and risks of treatment, and should be involved in the decision-making process to ensure that their needs and goals are met
• The use of patient-reported outcome measures (PROMs) can help to assess the effectiveness of treatment and improve patient-centered care 1

From the Research

Medical Decision Making Strategies for Strabismus (Dystopia)

There are no research papers provided that directly address the medical decision making strategies for strabismus (dystopia). The studies provided focus on Duchenne muscular dystrophy and its treatment options, particularly the use of corticosteroids.

Treatment Options for Duchenne Muscular Dystrophy

• The main goal in the treatment of Duchenne muscular dystrophy (DMD) is to maintain ambulation for as long as possible and to anticipate and manage the associated complications 2.
• Corticosteroid therapy, such as prednisone and deflazacort, is the only effective pharmacologic treatment for DMD 2, 3, 4.
• The optimal dose of prednisone is 0.75 mg/kg per day, up to a maximum of 40 mg/d 2.
• Daily prednisone treatment increases muscle strength and function, improves pulmonary function, and significantly slows the progression of weakness 2.
• Deflazacort has a similar effect on muscle strength, but it is not available in the United States 2.

Adverse Effects of Corticosteroid Therapy

• Excessive weight gain, behavioral abnormalities, cushingoid appearance, and excessive hair growth are all more common with corticosteroids than placebo 3, 4.
• Hair growth and cushingoid features are more frequent at 0.75 mg/kg/day than 0.3 mg/kg/day prednisone 3.
• Comparing daily versus weekend-only prednisone, both groups gain weight with no clear difference in body mass index (BMI) or in behavioral changes 3.

Future Research and Clinical Practice

• Non-randomised studies support the conclusions of functional benefits, but also identify clinically significant adverse effects of long-term treatment 3, 4.
• These benefits and adverse effects have implications for future research and clinical practice 3, 4.
• AAV-based gene replacement therapy is currently in clinical trials and shows significant promise in animal models 5.