Dear editorI read with great interest the article titled “Impact of strabismus on the quality of life of Chinese Han teenagers” by Tu et al.1 They concluded that strabismus could significantly reduce the health-related quality of life (QoL) of Chinese teenagers. I congratulate the authors for their enlightening study and would like to make some contributions to the study topic.What is QoL? A number of attempts to define QoL have been made, reflecting different approaches to the topic. However, I would like to define QoL as “general well-being defined in health and happiness rather than wealth”.In clinical practice, I see many adult patients with long-standing strabismus, some of them with no vision or light perception. I also have seen teenage boys covering the exodeviated eye with their hair or with a constant head position to look as orthotropic as possible. Many of them did not undergo surgery during their childhood or teenage years. The reason for not having surgery during the childhood period is because the patients’ parents were not interested in cosmetic treatment. In other cases, some of them did not have surgery because their doctors advised them against it, saying “It is a blind eye, no need for surgery.”Strabismus has been linked to a poorer QoL, which is primarily attributed to socioeconomic factors and the psychosocial effects of the disease. Affected patients are likely to have more difficulty finding employment than members of the general population, leading to lower overall socioeconomic status. Similarly, difficulty in interacting with other people can lead to altered overall happiness, reducing the QoL.Therefore, it is highly recommended that the surgery should be performed in teenagers with strabismus. Appearance has a great influence on social functioning.