Thirteen participants were interviewed, younger females (n = 4), older females (n = 3), younger males (n = 2) and older males (n = 4) (Table 1). All had undergone strabismus surgery for psychosocial reasons and were mean 12.2 months postoperatively (range 4.5–20 months). All had no diplopia and no measurable BSV, pre or postoperatively. All participants demonstrated suppression on sensory fusion testing and had at least perception of light vision in their poorest seeing eye.

Four main themes emerged from the analysis of the interviews: vision, task performance, physical symptoms and confidence.

Nine participants described improvements in their vision postoperatively (Table 2). With both eyes open focussing was reported as better, allowing improved and easier performance of tasks under natural viewing conditions. Vision was described as sharper and clearer, leading to being able to notice more of their surroundings. Improved vision was reported to be beneficial when using screens, performing near activities such as artwork or cooking, driving, walking around, reading signposts and during social activities. Improved vision was reported as less blurred, more natural, easier to see, more central, straighter and more comfortable. Improved vision enabled greater levels of concentration, longer concentration and being able to perform better at work. Participants reported feeling able to tell that the strabismic eye was in the right place and being able to make more accurate judgements about the position and alignment of objects. Participants described feeling less confused, less distracted by strabismus, or less like their strabismus was getting in the way. Having less confusion was perceived to be due to looking through both eyes postoperatively. Four participants reported improved vision specifically in busy environments.

Five participants reported improved eye movements, including being able to look further into different positions of gaze, more comfortable eye movements and the eyes moving together more. An increased field of peripheral vision was described by seven participants. This was perceived as having better, clearer or more vision. The impact of a greater field of peripheral vision was reported as being able to see trip hazards or people at the side, being more aware of personal surroundings and feeling safer. Requiring less head movement to see to the side was reported by four participants and was described as a direct consequence of having greater peripheral vision postoperatively. One participant described losing panoramic vision following surgery for exotropia made his vision more normal.

Despite having no measurable BSV postoperatively, two participants reported using their eyes together, leading to improved focussing. Four participants reported they were using their strabismic eye more postoperatively, including taking up fixation with the strabismic eye quicker, having greater peripheral vision and needing less head movement to see to the side. This was perceived as happening automatically, leading to improved vision, but not binocular vision. Three participants described better vision in their strabismic eye postoperatively. Others reported gaining control over their strabismus and less strabismic eye closure, particularly during periods of concentration.

One participant described visual aspects that were better (blur) and worse (vision). Three participants reported no visual change postoperatively, however two gave examples of improved vision during their interviews. Changes in vision may have been subtle, of little benefit, or may represent variation in interpretation of ‘vision’. Participants reported varying periods of adaptation postoperatively. Some were aware of immediate visual improvements, yet others described headaches or bumping into things during their early postoperative period.

Improved task performance was reported by seven participants postoperatively (Table 3). Driving was the most commonly reported improved task. Seven (out of eleven) drivers reported driving was improved or easier. Other reported changes related to driving, including greater confidence when driving and vision being improved, clearer, more in focus, using the strabismic eye more, having greater peripheral vision and needing to use less head movements to look to the side.

Postoperatively the ability to work and perform specific tasks, such as operating tills or machines, at work was described as improved. Improved work ability included making fewer mistakes, being better at their job, working for longer, being able to work harder, needing to take less rest breaks and having improved concentration at work. Improved work ability was associated with having improved vision, straighter eye alignment, the strabismic eye drifting less, greater confidence in work abilities and greater confidence interacting with people at work. Improved performance at work was also associated with postoperative improvements in using computers and screen-based devices. Participants reported being able to work for longer on the computer, doing more and harder work, improved focussing on computer-based tasks, and greater visual comfort when looking at screens.

Near tasks and practical daily activities were reported as improved postoperatively. Participants reported improved reading and tasks such as putting keys into door locks, wiring in dim lighting, home DIY, cooking, drawing and carpentry. Near task improvements were reported as performing tasks for longer, more accurately, with fewer breaks, less eye strain and less frustration. Improved vision was associated with improved near task performance, including improved focussing, using both eyes, having improved judgement of position and needing to close one eye less. Despite having no measurable BSV, improvements were reported in tasks involving judgments of depth and the position of objects in space, such as navigating steps or obstacles, picking up objects, threading and three-dimensional computer games.

Improved balance and less dizziness, clumsiness and bumping into things were reported postoperatively. Improved balance was associated with improved focussing with the strabismic eye and feeling like the eyes were working together. Less dizziness was associated with the strabismic eye drifting less.

After postoperative healing, participants described mostly improved physical symptoms, which they attributed to straighter eye position and the eye no longer turning, feeling tight or pulling (Table 3). Seven participants described completely resolved or improved eye pain, strain, discomfort, tiredness and epiphora postoperatively. Postoperatively headaches were reported as resolved or improved by six participants and worsened in one participant. One participant described worsened eye sensitivity and epiphora postoperatively. Having improved or resolved physical symptoms was associated with improved vision, closing the strabismic eye less, the eyes feeling more relaxed, improved concentration and being able to read for longer.

Participants reported improved physical symptoms during specific activities such as work, driving, near tasks and reading, or when tired or unwell. Participants associated improved physical symptoms with improved task and work performance, such as being able to read or work for longer, needing to take fewer rest breaks and no longer needing time off work (sick leave).

Improved eye alignment postoperatively was described as making a big impact on the lives of all the participants, leading to them feeling better and no longer worrying about their eyes and eye position (Table 4). Twelve participants described feeling happier, better in themselves, more confident and less stressed, anxious or worried postoperatively.

Improved interactions and communication with people was reported by all participants. Examples included being able to go out in public, look at people, make eye contact and have face-to-face communication. Socially participants reported feeling less embarrassed, more relaxed and confident when meeting new people, socialising more, fitting in and no longer avoiding social situations or communication with people. Additionally, in a work environment participants reported being given more face-to-face opportunities and being better at their job, as they were perceived to be friendlier, less rude or more communicative.

Participants described no longer receiving comments about their strabismus or being treated differently. The ability to look at another person and communicate with them were described as important factors in postoperatively having confidence to put themselves forward for opportunities such as applying for a new job, going for a job interview, applying for university and starting a new career. Increased confidence in vision and performing tasks such as driving and work abilities were also reported. Having greater confidence in their abilities, eyes and vision were significant factors in feeling able to drive, work more and try new activities.