Psychosocial aspects of mothers of children with strabismus

Psychological and Social Challenges Parents of Children With Strabismus Face in Qassim Region, Saudi Arabia: A Cross-Sectional Study

Aim Strabismus or squint is when one eye is misaligned or looking in a different direction. Some people consider strabismus as a cosmetic problem, causing patients in this condition to be mishandled, especially children, which might affect their vision and their quality of life. This study aimed to evaluate the psychological and social challenges faced by parents of children with strabismus during the years 2020-2021. Subjects and methods This is a cross-sectional study conducted among parents who have children with strabismus onset from birth till the age of 16 years. A self-administered questionnaire was distributed among parents during their visits to the vision eye specialist center. The questionnaire included socio-demographic characteristics of patients with strabismus and a 12-item questionnaire to measure the psychological impact on the parents of children with strabismus. Results Out of the 105 respondents, 65.7% were fathers, and 55.2% had children aged six years old or less. The most prominent strabismus type was esotropia (where the eye turns inward; 38.1%), while the most common nature of strabismus was intermittent (76.2%). The mean total score of psychological impact was 36.2 (SD=8.15) out of 60 points, with 62.9% considered as having an average psychological impact. Moreover, 77.1% of the respondents believed that strabismus could be treated and improved. Conclusion There was a moderate psychosocial challenge among parents of children with strabismus. Out of all the subjects, mothers who had prior visits to government hospitals were noticed to be greatly affected psychologically as compared to other subjects.

Knowledge and attitude towards strabismus among adult residents in Woreta town, North West Ethiopia: A community-based study

BACKGROUND

Strabismus is a visual disorder where the eyes are misaligned and point in different directions. Untreated strabismus can lead to amblyopia, loss of binocular vision, and social stigma due to its appearance. Since it is assumed that knowledge is pertinent for early screening and prevention of strabismus, the main objective of this study was to assess knowledge and attitudes toward strabismus in Woreta town, Northwest Ethiopia. Providing data in this area is important for planning health policies.

METHODS

A community-based cross-sectional study was done in Woreta town from April-May 2020 with a sample size of 424. A systematic random sampling technique was employed to achieve the required sample size. A pre-tested self-administered questionnaire was used to collect the data. Data were entered using epi-data version 3.1, then processed and analyzed via SPSS version 20. Descriptive and analytical statistics were employed to summarize the data. A p-value of less than 0.05 was used to declare statistical significance.

RESULT

A total of 401 individuals aged over 18 years participated, with a response rate of 94.5%. Of those who responded, 56.6% were males. Of all the participants, 36.9% were illiterate. The proportion of people with poor knowledge of strabismus was 45.1%. It was shown that 53.9% of the respondents had a favorable attitude. Older age, higher educational level, having a history of eye examination, and a having a family history of strabismus were significantly associated with good knowledge of strabismus. A higher educational level, older age, and hearing about strabismus were significantly associated with a favorable attitude toward strabismus.

CONCLUSION AND RECOMMENDATION

The proportion of good knowledge and favorable attitude towards strabismus were lower than previously reported in Gondar City, Northwest Ethiopia. There is a need to provide health education and promotion campaigns on strabismus to the community: what strabismus is, its' possible treatments and the need to bring children to the eye care center for early diagnosis and treatment.

Knowledge, Attitude, and Practice Among Parents of Strabismic Children in Saudi Arabia: A Cross-Sectional Study

Background Strabismus is a reversible condition that must be identified and treated during the critical period of childhood. Thus, this study aims to evaluate the degree of knowledge, attitude, and practice among parents of strabismic children in Riyadh, Saudi Arabia. Method To this end, a cross-sectional study was conducted from August 2021 to November 2021 with a sample size of 424 parents of children with strabismus seeking ophthalmologic consultants in private and governmental ophthalmology clinics in Riyadh, Saudi Arabia. A self-administered questionnaire was used to collect the data. The questionnaire contains knowledge-related questions about strabismus, beliefs-related questions, questions addressing the barriers parents face regarding strabismus in a child, and sources of information about cross-eye and its management. Data were analysed using the SPSS database version 21 (IBM Corp., Armonk, NY, USA). P-values <0.5 was used for clinical significance. Result We found that most parents know there is a relationship between strabismus and refractive errors (69%) and cross eye can be corrected (55%). Moreover, strabismus causes psychosocial difficulties (55%), low self-esteem, and low school performance. Parents of strabismic children believed that their love for their children is not affected due to crossed eyes (53%) and that strabismic children should not be taken to traditional healers (59%). Barriers faced during the management of strabismus are parents' negligence (76%), fear of surgery (34%), and high cost (29%). Doctors are the most used and preferred source of information among parents of strabismic children. Conclusion This study identifies gaps in knowledge, wrong beliefs in society, and the barriers faced by parents of strabismic children. Thus, raising awareness of the importance of detecting and treating strabismus early, avoiding psychosocial complications, and improving children's quality of life.

Association of Pediatric Strabismus and Functional Impairment: A Cross-sectional Nationwide Analysis

PURPOSE

To examine the association of childhood strabismus with functional limitation to identify particular domains of impairment.

METHODS

The authors analyzed 201 children ages 5 to 17 years with strabismus enrolled in the 1996-2015 Medical Expenditure Panel Surveys, representative annual surveys of the U.S.

POPULATION

Functional impairment was assessed using the Columbia Impairment Scale (CIS), a validated measure of behavioral and psychosocial functioning. A CIS score of 16 or greater defined clinically significant functional impairment. Multivariate regression models adjusted for age, sex, race, ethnicity, household income, geographic location, and insurance type were constructed to examine the association of strabismus diagnosis with overall impairment and individual domains of function.

RESULTS

Children diagnosed as having strabismus had higher rates of clinically significant functional impairment compared to those without strabismus (15.1% vs 9.1%, adjusted odds ratio [95% CI]: 1.82 [1.11 to 2.97], P = .02). Moreover, strabismus diagnosis was associated with higher rates of problems with getting along with their mother (1.70 [1.21 to 2.40], P = .003) and father (1.66 [1.16 to 2.38], P = .006), getting along with other children (1.67 [1.16 to 2.40], P = .006), behavior at home (1.94 [1.37 to 2.74], P = .0002), staying out of trouble (1.52 [1.04 to 2.23], P = .03), nervousness (1.49 [1.05 to 2.11], P = .02), and getting involved with sports and hobbies (1.55 [1.03 to 2.34], P = .04).

CONCLUSIONS

Childhood strabismus is associated with 1.8-fold greater odds of clinically significant functional impairment, with greater dysfunction in specific relationship and behavioral domains. Functional burden may be an important consideration in management decisions. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

Psychological Impact of Caregiving for Children With Eye Diseases: A Systematic Review and Meta-analysis

PURPOSE

To identify and characterize the psychological impact of caregiving for children with eye disease. Awareness of the caregiving experience and insight into the factors related to caregiver burden is necessary to support high-quality ophthalmic care and develop supportive interventions.

METHODS

The databases MEDLINE (Ovid), CINAHL, EMBASE, Cochrane Library, PsychINFO, PubMed, and Google Scholar were queried up to June 25, 2021. Studies included assessed the psychological impact of providing care to children with eye diseases. A risk of bias assessment was performed according to the Modified Downs and Black Checklist. Demographic data and measures of burden were extracted and tabulated.

RESULTS

A total of 2,823 articles were screened, 28 underwent data extraction, and 7 were included in the meta-analysis. The meta-analysis indicated significant levels of burden (40% mild, 95% CI: [0.28 to 0.53]; 59% moderate, 95% CI: [0.36 to 0.82]; 7% severe, 95% CI: [0.02 to 0.11]) and depression (26% mild, 95% CI: [0.17 to 0.35]; 8% moderate, 95% CI: [0.03 to 0.14]); 11% severe, 95% CI:[0.03 to 0.10]). Interventions such as educational programs, life skills training programs, and other home-based early intervention programs were shown to improve psychological well-being of families.

CONCLUSIONS

Caregivers experience significant levels of burden and depression, which may, in turn, affect the level of ophthalmic care they can provide for their children. Further studies investigating educational or psychological interventions for parents are needed, because the small number of studies that investigated these types of interventions have reported reduced parental stress and improved well-being. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

Psychosocial Improvements in Children and Their Parents Following Strabismus Surgery

PURPOSE

To evaluate the psychosocial effects of strabismus surgery, the authors investigated the psychiatric symptoms and quality of life of children with strabismus and their parents.

METHODS

Children with strabismus between 6 and 18 years old (n = 39) and their parents (n = 39) were included. Psychiatric problems and the health-related quality of life were assessed with the Child Behavior Checklist and Pediatric Quality of Life Inventory, respectively. The State-Trait Anxiety Inventory for Children and Beck Anxiety Inventory were administered to children and parents, respectively. All assessments were conducted before and 3 months after strabismus surgery.

RESULTS

Compared with preoperative assessments, children with strabismus had significantly fewer psychiatric problems and a better quality of life after the surgery (P < .001). Following surgery, decreased symptom levels of anxiety scores were also obtained from children and their parents (P < .001). The amount of ocular realignment was directly correlated with improvement in social and attention problems among children (r = 0.354 and r = 0.324, respectively; P < .05).

CONCLUSIONS

Successful strabismus surgery has positive effects on psychosocial functioning and quality of life in children and their families. Surgical interventions seem beneficial for the management of strabismus in improving both physical and mental health. [J Pediatr Ophthalmol Strabismus. 2022;59(4):261-268.].

The impact of strabismus on psychosocial heath and quality of life: a systematic review

Strabismus can hinder an individual's ability to perform daily functions and negatively affect their well-being. I examine the impact strabismus has on psychosocial health and quality of life in children and adults and evaluate the challenges confronted by parents of children with strabismus. Numerous misconceptions exist regarding the impact strabismus has on overall health. Negative attitudes persist toward those affected, resulting in difficulties with self-image. Individuals with strabismus are at increased risk for both visual system and psychiatric disorders. Misinformation regarding available treatment options for children and adults with strabismus continues to exist, resulting in decreased access to care. Improved education of health care providers can increase appropriate referrals and initiation of treatment. Treatment of strabismus is not merely cosmetic and has the potential to improve psychosocial health and quality of life for children and adults with and without diplopia.

Investigation of Stress and Distress Experienced by Guardians of Children with Strabismus and/or Amblyopia

Purpose: To investigate the stress experienced by the guardians of children with strabismus and/or amblyopia.Patients and Method: This study included 98 guardians of children with strabismus and/or amblyopia. First, guardians were asked to complete an independent questionnaire and the K6 screening scale. We analyzed stress associated with caring for their child. Second, we examined the responses to the free description questions of the consultation contents and benefits acquired from treatments.Results: A relationship between the attitudes of children regarding treatment and the receptive psychology of their guardians was established. Since strabismus and amblyopia treatments require practice and wearing glasses or patches in everyday living, guardians of affected children desired explanation regarding better and more specific treatments to improve the daily lives of their children. On the other hand, they had a feeling of anxiety about the future of their children. In addition, the stress-free guardians mentioned the importance of support, indicating that receiving support contributed to reducing their stress levels.Conclusion: Creating an environment that allows affected children to actively engage in their own treatment, while providing guardians with relevant information on the course of treatment and their children's future, may help reduce stress in guardians of affected children.

Health-Related Quality of Life (HRQoL) in Young Adults with Strabismus in India

INTRODUCTION

Strabismus has negative psycho-social and functional effects in adults. The impact can be minimised with surgery. However, in a low-income setting, it is important to evaluate the level of impact and prioritise the target population for intervention. The Adult Strabismus (AS-20) questionnaire is a reliable tool for assessment of Health-Related Quality of Life (HRQoL) in strabismic adults.

AIM

To assess the HRQoL in young adults with manifest strabismus through psychosocial and functional scores according to gender and direction of deviation using the AS-20 questionnaire.

MATERIALS AND METHODS

In this cross-sectional cohort study, 132 young adults who manifest horizontal strabismus were recruited and the AS-20 questionnaire was administered. Patient's demographic profile and type of strabismus were noted and compared with the overall mean scores of psycho-social and functional subscales. Data was analyzed using SPSS 21 and p-value less than 0.05 was considered statistically significant.

RESULTS

The participants comprised of 70 (53.03%) males and 62 (46.97%) females with a mean age of 24.5±3.57 years (range 18 to 38 years). The overall mean AS-20 score of young adults with strabismus was 61.62±12.61. The overall mean score for male and female were 65.54±13.53 and 57.68±13.46, respectively. Similarly, the mean scores for esotropes was 57.03±11.66 and 66.19±15.30 for exotropes. The overall mean scores were statistically significantly reduced (decreased QoL) in females as compared to males (CI 95%; p=0.002) and in esotropes as compared to exotropes (CI 95%; p=0.001). However, there was no significant difference between the psychosocial and functional score for all types of strabismus and genders (for all, p>0.05).

CONCLUSION

The Quality of Life (QoL) is affected through psychosocial and functional factors in adults with strabismus. Females and adults with esotropia faced greater difficulties in the QoL. We recommend clinicians to consider the impact on QoL while managing adult with strabismus.

Gain beyond cosmesis: demonstration of psychosocial and functional gains following successful strabismus surgery using the adult strabismus questionnaire adult strabismus 20

Background:

Strabismus adversely affects psychosocial and functional aspects; while its correction impacts positively.

Aim:

The aim was to evaluate the gains in scores: Overall scores (OASs), psychosocial subscale scores (PSSs) and functional subscale scores (FSSs) following successful surgical alignment.

Settings and Design:

We evaluated changed scores in the adult strabismus 20 (AS-20) questionnaire, administered before and after successful surgery.

Materials and Methods:

Thirty adults horizontal strabismics, were administered the AS-20, at baseline, and at 6-week and 3-month. Group-wise analysis was carried out based on gender, strabismus type (esotropia [ET] or exotropia [XT]), back-ground and amblyopia.

Statistical Analysis:

We used Wilcoxon, and Mann-Whitney U-tests. Significance was set at P ≤ 0.05.

Results:

At baseline, there were no significant differences within the groups, except that those with amblyopia significantly scored less than nonamblyopes in OAS (median scores: 53.8 vs. 71.3; P = 0.009) and FSS (56.3 vs. 85.3; P = 0.009). OAS, PSS and FSS showed significant gains at 6-week and 3-month (all Wilcoxon P < 0.001). Compared with males, females showed significantly more gain at 3-month (OAS: 37.9 vs. 28.7; P = 0.02), on account of PSS gain (49.6 vs. 37.5; P = 0.01). The ET performed better than XT only on the FSS at 6-week (28.7 vs. 15.0; P = 0.02). Vis-à-vis the nonamblyopes, the amblyopes showed significantly more benefit at 6-week alone (OAS: 18.7 vs. 28.7; P = 0.04), largely due to gains in PSS.

Conclusions:

Successful strabismus surgery has demonstrated significant gains in psychosocial, functional and overall functions. There is some evidence that gains may be more in females; with a trend to better outcomes in ET and amblyopes up to 6-week.

Childhood esotropia: child and parent concerns

PURPOSE

To identify specific health-related quality of life (HRQOL) concerns affecting children with esotropia as expressed by children or one of their parents (proxy) and concerns affecting the parents themselves.

METHODS

Sixty children with esotropia (0-17 years of age) and 1 parent for each child were prospectively enrolled. Individual semistructured interviews were conducted with children aged 5-17 years (n = 40) and 1 parent each for child ages 0-17 years. Transcripts of recorded interviews were evaluated using NVivo software. Specific concerns were identified from both child and parent interviews and coded. From these specific codes, broad themes were identified. Frequency of each theme was calculated, along with the frequency of specific codes within each theme.

RESULTS

Regarding the child's experience 6 broad themes were identified: visual function (mentioned by 32 of 40 children (80%) and by 50 of 60 parents (proxy assessment of child, 83%), treatment (78% and 85%), emotions (65% and 67%), social (58% and 68%), physical (58% and 32%), and worry (45% and 7%). Regarding the parents' own experience, 5 broad themes were identified: treatment (59 of 60 parents, 98%), worry (97%), emotions (82%), compensation for condition (80%), and affects family (23%).

CONCLUSIONS

A wide range of concerns were identified from interviews of children with esotropia and their parents. Concerns reflect the impact of esotropia in physical, emotional, and social domains, and specific concerns will be used for the development of questionnaires to quantify the effects of esotropia on children's and parents' quality of life.

Clinical Preoperative and Postoperative Symptoms of Exotropia

PURPOSE

To examine clinical preoperative and postoperative symptoms and changes in exotropia according to constancy and age.

METHODS

A survey was conducted of 50 patients on the day before and 1 month after exotropia surgery. Survey results were analyzed by type of exotropia at presentation and age. Changes in subjective symptoms from preoperatively to postoperatively were examined for stereopsis (5 items), asthenopia (5 items), and appearance (5 items). Each item was rated on a 5-point scale ranging from 0 to 4.

RESULTS

The mean age of the 50 patients was 10.6 ± 7.75 years, and there were 21 (41.2%) males and 29 (56.9%) females. Thirty-two patients with intermittent exotropia had no significant improvement in the stereopsis or asthenopia symptoms. However, they showed significant (P < .05) improvement in the appearance symptoms of squint and out of focus. Eighteen patients with constant exotropia showed significant improvements in the symptoms of tripping over objects or running into a wall in stereopsis and of squint and out of focus in appearance (P < .05). Postoperatively, all patients had significant improvement in appearance-related symptoms regardless of age (P < .05).

CONCLUSIONS

Patients with constant exotropia had improved symptoms in stereopsis, asthenopia, and appearance after surgery. Appearance was improved regardless of the type of exotropia or age.

Surgery versus Active Monitoring in Intermittent Exotropia (SamExo): study protocol for a pilot randomised controlled trial

BACKGROUND

Childhood intermittent exotropia [X(T)] is a type of strabismus (squint) in which one eye deviates outward at times, usually when the child is tired. It may progress to a permanent squint, loss of stereovision and/or amblyopia (reduced vision). Treatment options for X(T) include eye patches, glasses, surgery and active monitoring. There is no consensus regarding how this condition should be managed, and even when surgery is the preferred option clinicians disagree as to the optimal timing. Reports on the natural history of X(T) are limited, and there is no randomised controlled trial (RCT) evidence on the effectiveness or efficiency of surgery compared with active monitoring. The SamExo (Surgery versus Active Monitoring in Intermittent Exotropia) pilot study has been designed to test the feasibility of such a trial in the UK.

METHODS

DESIGN

an external pilot patient randomised controlled trial.

SETTING

four UK secondary ophthalmology care facilities at Newcastle NHS Hospitals Foundation Trust, Sunderland Eye Infirmary, Moorfields Eye Hospital and York NHS Trust.

PARTICIPANTS

children aged between 6 months and 16 years referred with suspected and subsequently diagnosed X(T). Recruitment target is a total of 144 children over a 9-month period, with 120 retained by 9-month outcome visit.Randomisation: permuted blocks stratified by collaborating centre, age and severity of X(T).

INTERVENTIONS

initial clinical assessment; randomisation (eye muscle surgery or active monitoring); 3-, 6- and 9-month (primary outcome) clinical assessments; participant/proxy completed questionnaire covering time and travel costs, health services use and quality of life (Intermittent Exotropia Questionnaire); qualitative interviews with parents to establish reasons for agreeing or declining participation in the pilot trial.

OUTCOMES

recruitment and retention rates; nature and extent of participation bias; nature and extent of biases arising from crossover or loss to follow-up; reasons for agreeing/declining participation; variability of cure rates (to inform power calculations for a definitive RCT); completion rates of outcome measures.

DISCUSSION

The SamExo pilot trial will provide important pointers regarding the feasibility of a full RCT of immediate surgery versus deferred surgery/active monitoring. The results of this pilot, including differences in cure rates, will inform the design of a definitive RCT.

TRIAL REGISTRATION

ISRCTN44114892.

Health-related quality of life in parents of children with intermittent exotropia

PURPOSE

To assess the health-related quality of life (HRQOL) of parents of children with intermittent exotropia with use of the newly developed condition-specific Parent Intermittent Exotropia Questionnaire (Parent IXTQ) and the generic PedsQL Family Impact Module (PedsQL FIM) and to compare the performance of both instruments.

METHODS

One parent was recruited for each of 59 children with intermittent exotropia (age range, 3-16; median, 7 years) and for each of 29 visually normal children (age range, 5-13; median, 8 years). The parent completed the Parent IXTQ and the PedsQL FIM. For each questionnaire, we compared median HRQOL scores between the intermittent exotropia group and visually normal group. We also calculated normal thresholds, which were defined as the 5th percentile score in the cohort of parents of visually normal children. The proportion of subnormal scores between questionnaires in parents of children with intermittent exotropia was compared.

RESULTS

The Parent IXTQ score was worse in the intermittent exotropia group than in the visually normal group (70.6 vs 94.1, p < 0.0001), whereas the PedsQL FIM scores were similar (97.9 vs 95.8, p = 0.8). More parents scored below normal when the Parent IXTQ was used than when the PedsQL FIM was used (31% vs 12%; p = 0.008, McNemar's test).

CONCLUSIONS

The Parent IXTQ detects subnormal HRQOL in parents of children with intermittent exotropia more often than the PedsQL FIM. It is possible that parental worry may influence management decisions in children with intermittent exotropia and therefore parental HRQOL is worthy of further study.

Comparison of psychosocial and emotional consequences of childhood strabismus on the families from rural and urban India

Purpose:

To compare the psychosocial consequences of horizontal comitant strabismus in children between the families of urban and rural India.

Materials and Methods:

In this cohort study, an eight-question quality-of-life instrument was administered by trained staff to the guardians of strabismic children from rural and urban areas by a live interview.

Results:

This study included 93 strabismic-children aged 4-16 years of which 52 were females. Forty-one had esodeviation and 52 had exodeviation. Seventy per cent parents were extremely distressed due to squint, 65% were extremely distressed due to people's remarks, 65% were extremely worried, 55% children were extremely distressed due to people's remarks, 57% children were severely ostracized, 38% had severe difficulty in communication and 50% had difficulty to cope; 64% parents were not advised a corrective surgery. The difference between families from rural and urban areas, or whether a male child was affected or a female child or for an esodeviation or an exodeviation was statistically not significant. The questionnaire had a good internal consistency (Cronbach's Alpha = 0.71).

Conclusions:

There was a significant negative psychosocial and emotional impact of childhood strabismus that was not affected by the rural or urban location of the family or the gender of the strabismic child or type of the deviation. The quality-of-life instrument can be used as part of the clinical examination for strabismic children.

Development and initial validation of quality-of-life questionnaires for intermittent exotropia

PURPOSE

The development and initial validation of patient-derived, health-related quality-of-life (HRQOL) questionnaires for intermittent exotropia (IXT).

DESIGN

Cross-sectional study.

PARTICIPANTS

In a development phase, 27 children (age, 2-17 years) with IXT and 1 of their parents. In an initial validation phase, 33 children with IXT and 49 control children (age, 5-17 years), along with 1 parent for each child. Children in the control group had no strabismus or amblyopia.

METHODS

Individual patient interviews generated 35 items for child and proxy (parental assessment of child's HRQOL) questionnaires and 46 items for a parent questionnaire. To reduce to a feasible number of items, questionnaires were administered to 5- to 17-year-old children with IXT (n = 15) and parents of 2- to 17-year-old children with IXT (n = 27). Responses were analyzed using standard item reduction methodology. Three final derived IXT questionnaires (IXTQ): child, proxy, and parent (12, 12, and 17 items, respectively) were administered to children with IXT and control children and to parents of IXT and control children. Likert-type scales ranging from never (100, best HRQOL) to almost always (0, worst HRQOL) were used.

MAIN OUTCOME MEASURES

Median scores for IXT and control groups, compared using Wilcoxon tests.

RESULTS

Median child scores were significantly lower (worse HRQOL) in the IXT group compared with the control group: 85 (quartiles, 73-92) versus 92 (quartiles, 79-96; P = 0.04). Median proxy IXTQ scores were significantly lower for IXT children than controls: 83 (quartiles, 75-94) versus 98 (quartiles, 92-100; P<0.0001). Median parent IXTQ scores also were significantly lower in the IXT group compared with the control group: 68 (quartiles, 56-79) versus 93 (quartiles, 87-99; P<0.0001).

CONCLUSIONS

A new 3-part patient-derived HRQOL questionnaire for children with IXT and their parents has been developed and validated, comprising child, proxy, and parent questionnaires. These questionnaires detect reduced HRQOL in children with IXT as reported by the children themselves and perceived by their parents (proxy report). Childhood IXT also seems to affect parent HRQOL. The IXTQ HRQOL questionnaires may prove useful in the clinical assessment of IXT and for clinical trials.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

The psychosocial aspects of strabismus in teenagers and adults and the impact of surgical correction

PURPOSE

To evaluate the effect of surgical correction of strabismus on psychosocial parameters in teenagers and adults with a history of childhood-onset strabismus.

METHODS

Consecutive patients older than 15 years of age who underwent strabismus surgery between 1997 and 2002 were contacted to complete a telephone questionnaire about their preoperative and postoperative psychosocial experiences. Formulas using the questionnaire answers were calculated to estimate the impact of strabismus on self-esteem, self-confidence, self-assessment of intelligence, effect on employment options, and interpersonal relationships preoperatively and to calculate the change in these parameters postoperatively.

RESULTS

One hundred twenty-eight patients were identified with childhood-onset strabismus. Eighty-six percent (110/128) of patients reported that the strabismus caused them embarrassment preoperatively. These patients also reported trouble making eye contact (114/128) and developing mannerisms to camouflage their strabismus (96/128). The calculated preoperative self-esteem, self-confidence, and perceived intelligence scores were significantly improved following strabismus surgery.

CONCLUSIONS

Strabismus surgery to restore ocular alignment has a significant effect on patients' self-esteem and self-confidence in patients with childhood-onset strabismus.

Redirecting Gaze to Improve the Cosmetic Appearance of Strabismus

PURPOSE

We studied a behavioral technique in which strabismics can reduce the detectability of their eye turn by appropriately redirecting their gaze. We tested the efficacy of this technique for various amounts of strabismus and different positions of gaze.

METHODS

We took digital images of a model gazing in different lateral directions and digitally edited them to simulate fixation with one eye on different lateral locations whereas the other eye was misaligned from the first by +/-0, 6, 12, 18, 24, and 30 Delta. Then we asked 22 lay observers to examine each of the images and to report whether or not they perceived eye contact and normal gaze.

RESULTS

The observers reported that our model appeared to look normal and gave them eye contact two-thirds of the time for up to 18 Delta of exotropia and 12 of esotropia when she looked half her prismatic deviation to the side opposite her eye turn.

CONCLUSION

By appropriately directing their gaze, both exotropes and esotropes can improve the cosmetic appearance of their strabismus and increase the perception that they are looking at the observer. This may be useful during job interviews and other social encounters where eye contact and a good impression are critical. A drawback is that large amounts of strabismus may require the gazer to look far to the side of the observer's head where it may be difficult to maintain gaze and the observer's facial expression may be hard to read. However, all patients may be counseled on which eye to look at when engaging in conversation, as looking at the appropriate rather than the inappropriate eye can reduce the perceived amount of their strabismus. Also, when their portrait is being taken, the full amount of eccentric gaze could easily be used.

A different aspect of corrosive ingestion in children: socio-demographic characteristics and effect of family functioning

OBJECTIVE

Corrosive ingestion is thoroughly investigated in terms of its complications and treatment modalities but to date family functioning, behavior, attitude and knowledge of mothers of children who ingested corrosives has not been investigated and socio-demographic data has rarely been mentioned. Therefore a study was planned to investigate the socio-demographic data, family functioning, knowledge, behavior and attitude of mothers of children who ingested corrosive materials.

METHODS

The mothers of 50 children who ingested corrosive materials and 60 controls were asked to answer a questionnaire which included socio-demographic data and questions about their attitude, behavior and knowledge of corrosive ingestion. The mothers were also asked to reply family assessment device (FAD) and parental attitude research instrument (PARI).

RESULTS

The average ages of the children were 5.31+/-2.32 in the corrosive group with an M:F ratio of 1:1. The level of education of both mothers (p=0.000) and fathers (p=0.000) in the corrosive group were lower than that of the controls. There was no difference between the two groups in terms of number of working mothers (p=0.085). In the corrosive group the families used to have three or more children (42%) and the socioeconomic status of this group was lower than the controls (p=0.001). In the corrosive group these substances were purchased unlabeled (64%) and kept mainly in coke bottles. The affective involvement dimension of the FAD and the attitude of over-parenting and democratic attitude dimensions of the PARI tests were significantly different in the corrosive group among mothers from lower educational level whereas no difference was detected among mothers from higher educational level in this regard.

CONCLUSION

It was found that both level of education of the parents and socioeconomic factors played important role in shaping the habits that might lead to corrosive ingestion in children. For the prevention of corrosive ingestion broad based strategies including education are required.