Hatt SR, et al. - A determination was pursued of the factors related to the failure of adult strabismus–20 (AS-20) health-related quality of life (HRQOL) scores to improve following strabismus surgery. A correlation was brought to the forefront between postoperative diplopia, depressive symptoms, type-D personality, and visually obtrusive facial anomalies with a failure of AS-20 scores to improve (remaining the same or worsening) following strabismus surgery. The association of nonstrabismus factors could display implications for patient treatment and warranted further research.