Can early childhood education cultivate more engaged citizens in midlife? Findings from urban youth of color.

Based on the belief that the effect of strabismus surgery depends on the its quantitative dosing, the amount of surgical muscle manipulation has been traditionally adjusted to the preoperative strabismus angle []. Recommended dosing tables for strabismus surgery have been propounded on the assumption that prism diopter correction per millimeter of recession or resection is predictable. An early dose-response curve for bilateral medial recession for infantile esotropia was published in 1985 []. However, the dose-response graph demonstrated significant variability of surgical effects, especially for esotropia exceeding 30Δ. Exotropia is notorious for its high recurrence rate; multiple studies have been performed to investigate factors possibly affecting surgical outcomes [–]. Currently there is little consensus on either unilateral or bilateral surgery, nor on the number of horizontal extraocular muscles, and the amount of surgery to be performed on them, for treating large angle exotropia. Some surgeons advocate performing maximal or supramaximal doses on two horizontal muscles [–], while others recommend three-muscle surgery to avoid lateral incomitance [–]. Some studies suggest that the results of strabismus surgery may not be closely related to the amount of surgery performed. Tran et al. suggest that e preoperative deviation was the most powerful predictor of the surgical outcome []. By reanalyzing the data of Tran et al., Archer concludes that the preoperative deviation was better correlated with surgical outcome than the actual amount of surgery []. However, such analyses are confounded by intentional modification of the surgical dose based on pre-operative strabismus magnitude. The ideal test of an hypothesized relationship between surgical dose and response would require fixed surgical dosing independent of pre-operative strabismus angle. The published literature does not contain such data for exotropia.