"I have a question about the case in [the Question of the Week] 2004 series (September 21, 2004). [Editor's Note: This question features a patient with a fairly large in-turning of the right eye and a fundus photo that demonstrates traction on the macula. The patient had a birth weight of 7 lbs. and was said to be full term. The macula was shifted nasally.] If the girl demands a cosmetic surgery to improve her appearance, what should we do -- strabismus surgery or macular surgery?" 

The eye is already looking "straight ahead" as far as the macula is concerned. Straightening the eyeball would create diplopia. Retina surgery in an already severely distorted retina would be very likely to destroy what vision the patient has. Unless the patient suppresses, I would not want to be the one to do muscle surgery because it would not be in the patient's best interests. This is a very difficult situation to explain to a patient. I understand this, but do your best to make your patient appreciate the vision that the eye has.