Robinson's Computerized Strabismus Model Comes of Age.

In this article we review our further development of D.A. Robinson's computerized strabismus model. First, an extensive literature study has been carried out to get more accurate data on the anatomy of the average eye and the eye muscles, and about how these vary with age and with refraction. Secondly, the force-length relations that represent the mechanical characteristics of the eye muscles in the model have been determined more accurately in vivo recently, and the model was changed accordingly. Thirdly, many parameters that were free in the original model and not derived from in vivo measurements were replaced by derivatives from in vivo measurements or made redundant. Fourthly, the ease of operation was improved greatly and the algorithms were made so much faster that a calculation for nine positions of gaze now takes ten seconds on a handheld HP 200LX Palmtop. The predictions of the model compared well with clinical results in horizontal muscle surgery, oblique muscle surgery, forced duction tests and abducens, oculomotor or trochlear palsies. Consequently, complex strabismus surgery in our clinic is now guided by the predictions of the computerized model.