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Jin K, Aboobakar IF, Whitman MC, Oke I. Mental Health Conditions Associated With Strabismus in a Diverse Cohort of US Adults. JAMA Ophthalmol 2024; 142:472-475. [PMID: 38573646 PMCID: PMC11099685 DOI: 10.1001/jamaophthalmol.2024.0540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/03/2024] [Indexed: 04/05/2024]
Abstract
Importance Greater understanding of the association between strabismus and mental health conditions across sociodemographic backgrounds may inform strategies to improve mental well-being in this population. Objective To describe the association of strabismus with mental health conditions in a diverse cohort of US adults. Design, Setting, and Participants This cross-sectional study used data from the National Institutes of Health's All of Us Research Program, an ongoing program launched in 2015. The study included 3646 adults (aged ≥18 years) with strabismus and 3646 propensity score-matched controls. Statistical analysis was conducted from September 12, 2023, to January 29, 2024. Main Outcomes and Measures Adults with strabismus were propensity score matched on age, gender, race and ethnicity, income, educational level, and insurance status in a 1:1 ratio with adults without strabismus. The prevalences of anxiety, depression, substance use and addiction, bipolar disorder, and schizophrenia spectrum disorder among adults with strabismus were compared with controls. Logistic regression was used to evaluate the association of mental health conditions with sociodemographic factors in each group. Results This study included 3646 adults with strabismus (median age, 67 years [IQR, 53-76 years]; 2017 women [55%]) and 3646 propensity score-matched controls (median age, 67 years [IQR, 53-76 years]; 2017 women [55%]). Individuals with strabismus had higher prevalences of anxiety (1153 [32%] vs 519 [14%]; difference, 17%; 95% CI, 15%-19%; P < .001), depression (1189 [33%] vs 514 [14%]; difference, 19%; 95% CI, 17%-20%; P < .001), substance use and addiction (116 [3%] vs 51 [1%]; difference, 2%; 95% CI, 1%-3%; P < .001), bipolar disorder (253 [7%] vs 101 [3%]; difference, 4%; 95% CI, 3%-5%; P < .001), and schizophrenia spectrum disorder (103 [3%] vs 36 [1%]; difference, 2%; 95% CI, 1%-3%; P < .001) compared with individuals without strabismus. Among adults with strabismus, higher odds of mental health conditions were associated with younger age (odds ratio [OR], 1.11 per 10-year decrease; 95% CI, 1.06-1.16 per 10-year decrease), female gender (OR, 1.62; 95% CI, 1.41-1.85), Black or African American race and ethnicity (OR, 1.22; 95% CI, 1.01-1.48), low income (OR, 3.06; 95% CI, 2.56-3.67), and high school education or less (OR, 1.58; 95% CI, 1.34-1.85). Conclusions and Relevance In a diverse and nationwide cohort, adults with strabismus were more likely to have mental health conditions compared with adults without strabismus. Further investigation into the risk factors for poor mental health among adults with strabismus across sociodemographic backgrounds may offer novel opportunities for interventions to improve mental well-being in this population.
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Affiliation(s)
- Kimberly Jin
- University of Massachusetts Chan School of Medicine, Worcester
| | - Inas F. Aboobakar
- Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston
| | - Mary C. Whitman
- Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Isdin Oke
- Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
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Ehlers M, Mauschitz MM, Wabbels B. Implementing strabismus-specific psychosocial questionnaires in everyday clinical practice: mental health and quality of life in the context of strabismus surgery. BMJ Open Ophthalmol 2023; 8:e001334. [PMID: 37558407 PMCID: PMC10414054 DOI: 10.1136/bmjophth-2023-001334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/21/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Strabismus can have a great negative impact on the quality of life and the well-being of affected patients. In the past, these aspects were often neglected and, compared with somatic functioning, placed in the background. The aim of our study is to elicit factors influencing satisfaction with strabismus surgery, quality of life and expectations of surgery in order to better predict who will benefit the most and who may need further support. METHODS We made a selection of suitable questionnaires to assess psychosocial aspects of strabismus and decided for Adult Strabismus 20 Questionnaire, Amblyopia and Strabismus Questionnaire, Diplopia Questionnaire, Expectations of Strabismus Surgery Questionnaire and Hospital Anxiety and Depression Scale. We then translated these measures (if not available in German). The patients filled out these forms as part of their preoperative orthoptic and ophthalmological assessment as well as approximately 3 months after strabismus surgery. RESULTS We enrolled 59 patients in this study. Postoperative strabismus-related quality of life was higher after surgery and anxiety and depression levels were lower. Satisfaction with surgery was lower with higher postoperative angle and diplopia; the latter was also a determinant of lower postoperative quality of life. Higher expectations of strabismus surgery were present with higher depression levels and higher preoperative strabismus angle. CONCLUSION Our data indicate that strabismus surgery may cause a significant improvement in several psychosocial domains. There is evidence that psychosocial factors can have significant impact on expectations with surgery. Hence, it is important to consider mental health aspects of this disease in order to treat patients in the best possible way.
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Affiliation(s)
- Maja Ehlers
- Department of Ophthalmology, University Hospital of Bonn, Bonn, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Cologne, Germany
| | | | - Bettina Wabbels
- Department of Ophthalmology, University Hospital of Bonn, Bonn, Germany
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3
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Mason A, Joronen K, Lindberg L, Koivisto AM, Fagerholm N, Rantanen A. Health-Related Quality of Life in Adult Patients with Strabismus-Translation and Psychometric Testing of the Adult Strabismus Questionnaire (AS-20) into Finnish. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2830. [PMID: 36833527 PMCID: PMC9956330 DOI: 10.3390/ijerph20042830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
(1) Strabismus has an impact on individuals' health-related quality of life. The impact should be assessed with valid patient-reported outcome measures such as the Adult Strabismus Questionnaire (AS-20). The AS-20 was further refined using a Rasch analysis for the American population. The aims of the study were to translate and culturally adapt the AS-20 into Finnish and to evaluate the psychometric properties of the Finnish AS-20. (2) The guidelines of the Professional Society for Health Economics and Outcomes Research steered the process and four items were added from the original data as Finnish additions. The construct and convergent validity and internal consistency were evaluated via psychometric testing for three potential Finnish AS-20 structures. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was applied. (3) The participants (n = 137) reported that the translation was clear and understandable. All structures showed high reliability and internal consistency as measured using Cronbach alpha values. The convergent validity assessed using Spearman's correlation coefficients between the structures and one item of Satisfaction with Life Scale indicated very low to moderate positive correlations. The construct validity evaluated using a confirmatory factor analysis revealed the refined AS-20 structure to be satisfactory. (4) The refined AS-20 can be used in clinical practice and research, but further validation is recommended.
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Affiliation(s)
- Anna Mason
- Faculty of Social Science, Health Sciences, Tampere University, 33014 Tampere, Finland
- Helsinki University Hospital, Helsinki University, 00290 Helsinki, Finland
| | - Katja Joronen
- Department of Nursing Science, University of Turku, 20014 Turku, Finland
| | - Laura Lindberg
- Helsinki University Hospital, Helsinki University, 00290 Helsinki, Finland
| | - Anna-Maija Koivisto
- Faculty of Social Science, Health Sciences, Tampere University, 33014 Tampere, Finland
| | - Nina Fagerholm
- Helsinki University Hospital, Helsinki University, 00290 Helsinki, Finland
| | - Anja Rantanen
- Faculty of Social Science, Health Sciences, Tampere University, 33014 Tampere, Finland
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Hu MY, Pan YC, Zhang LJ, Liang RB, Ge QM, Shu HY, Li QY, Pei CG, Shao Y. Altered Brain Activity in Patients With Comitant Strabismus Detected by Analysis of the Fractional Amplitude of Low-Frequency Fluctuation: A Resting-State Functional MRI Study. Front Hum Neurosci 2022; 16:874703. [PMID: 35463927 PMCID: PMC9027334 DOI: 10.3389/fnhum.2022.874703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/21/2022] [Indexed: 12/04/2022] Open
Abstract
More and more studies showed that strabismus is not simply an ocular disease, but a neuro-ophthalmology disease. To analyze potential changes in brain activity and their relationship to behavioral performance in comitant strabismus patients and healthy controls. Our study recruited 28 patients with comitant strabismus and 28 people with matched weight, age range, and sex ratio as healthy controls. Using resting-state functional magnetic resonance imaging, we evaluated fALFF to compare spontaneous brain activity between comitant strabismus and healthy controls. We did hospital anxiety and depression scale questionnaires for these patients. We found significantly lower fALFF value in comitant strabismus patients compared with controls in the left frontal superior medial gyrus and the right middle cingulum. In the latter region, fALFF was significantly negatively correlated with the hospital anxiety and depression scale, as well as the duration of disease. Receiver operating characteristic curve analysis indicated that the fALFF method has clear potential for the diagnosis of comitant strabismus patients. These results revealed abnormal spontaneous activity in two brain regions of comitant strabismus patients, which may indicate underlying pathologic mechanisms and may help to advance clinical treatment.
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5
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Gore S, Grimaldi G, Mazzone G, Collin R, Savino G, Pagnoni M, Modugno A. Treatment strategies and long-term outcomes in patients with congenital microphthalmia-anophthalmia with cyst. Br J Ophthalmol 2022; 107:750-755. [PMID: 35101939 DOI: 10.1136/bjophthalmol-2020-318089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/13/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Microphthalmia and anophthalmia are rare conditions, which represent ocular maldevelopment; both may be associated with orbital cysts. Current literature recommends retention to stimulate orbital growth during socket rehabilitation but does not illustrate their potential to deform the periocular tissues. This study aims to illustrate the long-term outcomes when other elements, such as forniceal and lid development, are also considered when formulating bespoke treatment plans for patients. METHODS Retrospective case series of 78 patients attending a single prosthetics clinic between 1988 and 2020. Clinical and surgical notes, radiological imaging, clinical photographs and patient/doctor satisfaction questionnaires were used to report patient outcomes and natural history data. RESULTS 89 sockets of 78 patients (11 bilateral) were included; average age of presentation being 2.8 years (9 days to 29.5 years). Cysts were clinically detected (48%) or were incidental findings (52%). The mean follow-up time was 7.2 years (6 months to 28 years). Cysts in 46% of sockets underwent surgical excision while the remainder were retained. Satisfaction surveys were obtained for 75 patients, with cosmetic outcomes rated as 'excellent' or 'good' in 90% of cases by physicians and 97% of cases by patients or guardians. CONCLUSION The favourable long-term outcomes in this study have resulted from bespoke plans which considered periocular tissue development, regional orbital growth and orbital volume replacement. The authors contemplate cyst excision if the prosthetic fitting or retention is impeded by the cyst as this often heralds the increased risk of long-term periocular distortion.
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Affiliation(s)
- Sri Gore
- Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK .,Department of Ophthalmology, Ocularistica Italiana, Rome, Italy
| | - Gabriela Grimaldi
- Department of Ophthalmology, Ocularistica Italiana, Rome, Italy.,Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Richard Collin
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Gustavo Savino
- Opthalmology, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Mario Pagnoni
- Department of Maxillo-facial surgery, Your Face Surgery Villa Parioli Clinic, Rome, Italy
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Kumaran SE, Khadka J, Baker R, Pesudovs K. Patient‐reported outcome measures in amblyopia and strabismus: a systematic review. Clin Exp Optom 2021. [DOI: 10.1111/cxo.12553] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sheela E Kumaran
- Discipline of Optometry and Vision Science, Flinders University, Adelaide, South Australia, Australia,
| | - Jyoti Khadka
- Discipline of Optometry and Vision Science, Flinders University, Adelaide, South Australia, Australia,
| | - Rod Baker
- Discipline of Optometry and Vision Science, Flinders University, Adelaide, South Australia, Australia,
| | - Konrad Pesudovs
- Discipline of Optometry and Vision Science, Flinders University, Adelaide, South Australia, Australia,
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The impact of strabismus on psychosocial heath and quality of life: a systematic review. Surv Ophthalmol 2021; 66:1051-1064. [PMID: 33773997 DOI: 10.1016/j.survophthal.2021.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 02/07/2023]
Abstract
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.
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Flodin S, Rydberg A, Pansell T, Grönlund MA. Measuring health-related quality of life in individuals with cyclodeviation using the Adult Strabismus 20 (AS-20) questionnaire. J AAPOS 2021; 25:20.e1-20.e6. [PMID: 33326839 DOI: 10.1016/j.jaapos.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/18/2020] [Accepted: 08/22/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess health-related quality of life (HRQoL) in patients diagnosed with cyclodeviation and to evaluate subjective change following surgical treatment using the Adult Strabismus-20 (AS-20) questionnaire. METHODS A prospective cohort study was performed from 2014 to 2019 on 29 adult patients with cyclodeviation and cyclodiplopia who were due to undergo corrective strabismus surgery by the same surgeon. The group was divided into two subgroups, according to the type of surgery required for fusion. All scores were analyzed for the whole sample and subgroups. Preoperative scores were compared with those of control patients. RESULTS Pre- and postoperative QoL scores were successfully collected from 26 patients (mean age, 56 years; 8 female) using the AS-20 questionnaire. Scores were significantly higher for control subjects than for patients in the cyclodeviation group (P = 0.0001). Postoperative scores for all 20 questionnaire questions were significantly improved for all patients (P = 0.002). There was a significant improvement in the functional subscale score (P = 0.001), but not in the psychosocial subscale score (P = 0.23). Results were enhanced by Rasch analysis. CONCLUSIONS Cyclodeviation patients demonstrated significantly lower scores than controls. The functional scores were significantly lower than the psychosocial scores, in contrast to other forms of strabismus. Strabismus surgery had a significant effect on quality-of-life scores in this group of adults.
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Affiliation(s)
- Sara Flodin
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden.
| | - Agneta Rydberg
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden
| | - Tony Pansell
- Department of Clinical Neuroscience, Division of Eye and Vision, Karolinska Institutet, Stockholm, Sweden
| | - Marita Andersson Grönlund
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Ophthalmology, Mölndal, Sweden
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9
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Liu YX, Li B, Wu KR, Tang LY, Lin Q, Li QH, Yuan Q, Shi WQ, Liang RB, Ge QM, Shao Y. Altered white matter integrity in patients with monocular blindness: A diffusion tensor imaging and tract-based spatial statistics study. Brain Behav 2020; 10:e01720. [PMID: 32558355 PMCID: PMC7428480 DOI: 10.1002/brb3.1720] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/28/2020] [Accepted: 03/03/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Visual deprivation can lead to abnormal and plastic changes in the brain's visual system and other systems. Although the secondary changes of gray matter in patients have been well studied, the study of white matter is rare. In fact, subtle changes in white matter may be revealed by diffusion tensor imaging, and tract-based spatial statistics can be used to analyze DTI image data. PURPOSE In the present study, diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS) were used to investigate abnormal structural changes in the white matter (WM) of patients with monocular blindness (MB). METHODS We recruited 16 healthy controls (HC) (fourteen males and two females) and 16 patients (fifteen males and one female) with right-eye blindness (without differences in left-eye vision). All patients were of similar age. Data acquisition was performed using magnetic resonance imaging (MRI) and DTI. Voxel-based whole brain comparisons of fractional anisotropy (FA) and radial diffusivity (RD) of WM fibers in patients and HC were performed using the TBSS method. The mean FA and RD values for altered brain regions in MB patients were analyzed via the receiver operating characteristic (ROC) curve. Correlation analysis was performed to investigate the relationships between the average FA (RD) value of the whole brain and anxiety score, depression score, and visual function questionnaire score in MB patients. RESULTS In MB patients, the mean FA of the whole brain was decreased versus HC. Moreover, the FA values of the corpus callosum, the corona radiata, the posterior thalamic radiation, and the right retrolenticular part of internal capsule were significantly decreased. In addition, the average RD value of the whole brain in MB patients was higher than that observed in HC. The mean FA and RD values of brain regions were analyzed using the ROC curve, and the results showed that the area under the ROC curve was more accurate. Furthermore, the average FA and RD values of the whole brain were significantly correlated with anxiety score, depression score, and visual function-related quality of life score. CONCLUSION DTI and TBSS may be useful in examining abnormal spontaneous alterations in the WM of MB patients. The observed changes in FA and RD values may imply the larvaceous neurological mechanism involved in MB.
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Affiliation(s)
- Yu-Xin Liu
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Biao Li
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kang-Rui Wu
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Li-Ying Tang
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Eye Institute of Xiamen University, Xiamen University School of Medicine, Xiamen, China
| | - Qi Lin
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qing-Hai Li
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qing Yuan
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wen-Qing Shi
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Rong-Bin Liang
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qian-Min Ge
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yi Shao
- Department of Ophthalmology, Jiangxi Province Clinical Ophthalmology Institute, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Factors influencing the self-reported sense of deviation in adults with successful surgical outcomes for strabismus. BMC Ophthalmol 2020; 20:9. [PMID: 31906894 PMCID: PMC6945548 DOI: 10.1186/s12886-019-1299-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine whether a sense of deviation remains in adults with successful motor alignment who fulfil diplopia criteria after surgery and to examine the factors associated with this judgement. METHODS This was a retrospective study. Adult patients defined as having a successful outcome based on more than 1 year of post-operative follow-up visits were included in the study. The sense of deviation was determined at the last visit. Pre- and post-operative deviation and characteristics including age, gender, education level, occupation, diagnosis, size of deviation, extraocular movement (EOM), binocular function, and health-related quality of life (HRQOL) were recorded. RESULTS In total, 22 (24%) of the 91 adults with successful surgical outcomes reported a sense of deviation. No significant differences were noted between subjects with and without a sense of deviation regarding patient demographics, pre- and post-operative deviation, changes in deviation, sensory fusion or EOM. Subjects with a sense of deviation had an increased prevalence of and larger post-operative vertical deviation, poorer stereo function, and lower HRQOL scores than those with no sense of deviation. The presence of post-operative vertical deviation was associated with a sense of deviation. CONCLUSIONS Approximately one-fourth (24%) of adults defined as having successful surgical outcomes who still had a sense of deviation exhibited worse stereo function, higher vertical deviation size and lower HRQOL scores. The presence of 3 to 5 prism dioptres(pd) of vertical deviation would be the main factor associated with a sense of deviation post-operatively.
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11
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Sadiq SA, Pattinson R, Poole HM, Bundy C. Psychological distress and coping following eye removal surgery. Orbit 2019; 39:175-182. [PMID: 31573371 DOI: 10.1080/01676830.2019.1658789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Psychological distress is reasonably well documented in people with facial disfigurement; however, in patients following eye removal surgery this has not been studied adequately. We hypothesised that lower distress levels would be associated with age and more adaptive coping strategies and that women would be more likely to report higher levels of distress and, therefore, use maladaptive coping strategies.Methods: This exploratory, cross-sectional study measured distress and coping in a sample of 56 post enucleation or evisceration patients. The Hospital Anxiety and Depression Scale and the Brief COPE measured distress and coping strategies.Results: In all, 25.5% and 10.9% of the sample had high levels of anxiety and depression, respectively. Significant associations were found between levels of distress, coping strategies and demographic variables (p < .05). There were significant differences in coping strategies between those with higher and lower levels of distress (p < .05). Females reported higher levels of anxiety (U = 202.5, p < .01) and depression (U = 229, p < .05) than males. Those who experienced enucleation or evisceration aged between 20 and 39 years reported significantly higher levels of depression compared with other age groups (U = 68.5, p < .01).Conclusions: There was a relatively low level of distress across the whole sample, but we found high levels of distress in a considerable proportion (18.18%) of participants. Participants' coping strategies and levels of distress were correlated. Females and participants aged between 20 and 39 years at time of eye removal were particularly vulnerable to distress.
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Affiliation(s)
- S A Sadiq
- School of Natural Sciences and Psychology, Faculty of Science Liverpool John Moores University, Liverpool, UK.,Cataract & Oculoplastics, Manchester Royal Eye Hospital, Manchester, UK
| | - R Pattinson
- Faculty of Biology, Medicine & Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - H M Poole
- School of Natural Sciences and Psychology, Faculty of Science Liverpool John Moores University, Liverpool, UK
| | - C Bundy
- Faculty of Biology, Medicine & Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
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The long-term effects of microvascular decompression on social phobia and health-related quality of life in patients with hemifacial spasm: a 3-year prospective study. Acta Neurochir (Wien) 2019; 161:2035-2042. [PMID: 31368052 DOI: 10.1007/s00701-019-04023-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/22/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although not a life-threatening condition, hemifacial spasm (HFS) frequently leads to social phobia because it causes significant facial disfigurement and consequently reduces health-related quality of life (HRQoL). The purpose of the current study was to examine the long-term effects of MVD on psychological aspects and HRQoL in HFS patients with social anxiety over a 36-month follow-up. METHODS Thirty patients with HFS who underwent MVD from January 2015 to May 2015 were included in this prospective study. Clinical data, including standardized measures of general anxiety and depression (Hospital Anxiety Depression Scale (HADS)), social anxiety (Liebowitz Social Anxiety Scale (LSAS)), and the severity of HFS, were collected postoperatively, and 6 months and 36 months after MVD. Likewise, data on HRQoL were collected at baseline, and 6 months and 36 months after MVD using the Korean version of the Short Form 36 (SF-36). RESULTS Twenty-two patients who completed the 36-month follow-up were classified into social phobia group and non-social phobia group based on the LSAS total scores of 60. Repeated measures analysis of variance demonstrated significant differences between the two groups over time for the total LSAS score (p < 0.001), anxiety subscale score of the HADS (p = 0.002), and the Mental Component Summary (MCS) (p = 0.046) of the SF-36. A comparison of these two groups in terms of differences observed in their scales at 6 months after MVD has shown that the improvements of the social phobia group in HADS anxiety subscale (p = 0.010), LSAS total score (p = 0.008), and MCS (p = 0.040) were significantly more improved than the those of non-social phobia group. And at 36 months after surgery, the improvement of the scales mentioned above was maintained, and additionally Vitality (p = 0.040) and Mental Health (p = 0.040) dimensions showed a statistically significant improvement. CONCLUSIONS The improvements previously observed in psychological aspects and HRQoL over a short-term follow-up after MVD in HFS patients with social phobia were maintained for at least 36 months after MVD.
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Hatt SR, Leske DA, Philbrick KL, Holmes JM. Factors Associated With Failure of Adult Strabismus-20 Questionnaire Scores to Improve Following Strabismus Surgery. JAMA Ophthalmol 2019; 136:46-52. [PMID: 29167898 DOI: 10.1001/jamaophthalmol.2017.5088] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Health-related quality of life (HRQOL) typically improves following strabismus surgery. Nevertheless, for some patients, HRQOL does not improve, and reasons for this are unknown. Objective To identify factors associated with failure of adult strabismus-20 (AS-20) HRQOL scores to improve following strabismus surgery. Design, Setting, and Participants Prospective observational case series at the Mayo Clinic, Rochester, Minnesota, comprising 276 adults, between July 2012 and August 2016. Main Outcomes and Measures Participants completed the AS-20 HRQOL questionnaire, diplopia questionnaire, Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) (depressive symptoms), and Type-D Scale 14 questionnaire (type-Distressed [type-D] personality) both preoperatively and 6 weeks postoperatively. To assess factors associated with failure of HRQOL to improve (no change or decrease in score), univariate and multiple logistic regression analyses were performed. Each of the 4 AS-20 domains (self-perception, interactions, reading function, and general function) were analyzed separately including only patients able to improve at least by the magnitude of previously defined 95% limits of agreement. Factors assessed were age (at onset and at surgery), sex, number of previous surgeries, presence of visually obtrusive facial anomaly, visual acuity, preoperative and postoperative diplopia questionnaire scores, alignment (as a vector), presence of esotropia, presence of a vertical deviation, CESD-R scores, and type-D personality. Stepwise multiple logistic regression analyses were performed to assess factors associated with failure of AS-20 scores to improve for each domain. Results Of the 276 participants, the median age was 57 years (range, 18-91 years), 153 were women (55%), and 266 were white (96%). Failure to improve was associated with worse diplopia postoperatively on the self-perception (adjusted risk ratio [RR], 1.01; 95% CI, 1.00-1.02), reading function (adjusted RR, 1.02; 95% CI, 1.01-1.03), and general function domains (adjusted RR, 1.02; 95% CI, 1.01-1.03). In addition, failure to improve on the self-perception domain was associated with type-D personality postoperatively (adjusted RR, 4.26; 95% CI, 1.90-9.57) and failure to improve on the interactions domain was associated with postoperative depressive symptoms (adjusted RR, 1.04; 95% CI, 1.02-1.06) and coexisting visually obtrusive anomaly (adjusted RR, 2.12; 95% CI, 1.04-4.32). Conclusions and Relevance Postoperative diplopia, depressive symptoms, type-D personality, and visually obtrusive facial anomalies were associated with failure of AS-20 scores to improve (remaining the same or worsening) following strabismus surgery. The association of nonstrabismus factors may have implications for patient treatment and is worthy of continued study.
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Affiliation(s)
- Sarah R Hatt
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - David A Leske
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
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Characterization of Intelligence in Children with Exotropia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173008. [PMID: 31438468 PMCID: PMC6747520 DOI: 10.3390/ijerph16173008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/16/2019] [Accepted: 08/19/2019] [Indexed: 01/07/2023]
Abstract
The effect of exotropia on the intelligence of children is unknown. This study aimed to assess the intelligence in children with exotropia and investigate the influence of the main clinical indexes of strabismus on intelligence. Eighty-four participants aged 8–12 years were enrolled, including 37 patients with exotropia (exotropia group) and 47 normal individuals (normal group). Intelligence was assessed by the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV), including the Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), Processing Speed Index (PSI), and Full-Scale Intelligence Quotient (FSIQ). The exotropia group had a significantly lower PRI score but a higher PSI score than the normal group. However, there was no significant difference in the WMI, VCI, and FSIQ between groups. Multiple linear regression showed that PRI–WMI and PRI–PSI differences were significantly lower in the exotropia group. Inter-subscale correlations analysis showed that the pattern of intelligence structure was different between groups. The type of exotropia, angle of deviation, duration of symptoms, and stereoacuity had no effect on the intelligence of children with exotropia. Children with exotropia had a relatively worse performance in the perceptual reasoning skill but a better processing speed and a different pattern of intelligence structure.
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Wang Z, Zhou J, Xu Y, Yin H, She X, Bian W, Wang X. Development of a conceptual model regarding quality of life in Chinese adult patients with strabismus: a mixed method. Health Qual Life Outcomes 2018; 16:171. [PMID: 30176900 PMCID: PMC6122201 DOI: 10.1186/s12955-018-0991-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/01/2018] [Indexed: 11/24/2022] Open
Abstract
Background Substantial challenges have been reported in China in terms of the large number of adult patients with strabismus and their poor quality of life. Quality of life is a cultural concept that varies according to personal feelings and perceptions, and it is influenced by physical, psychological and social factors. However, to date, there has been no mixed-method research of the quality of life of Chinese adult patients with strabismus, and no conceptual model has been reported. This study aimed to utilize mixed methods to explore the influence of strabismus on health-related quality of life in Chinese adult patients and to develop a conceptual model. Methods Thirty adult patients with strabismus from three tertiary hospitals in China participated in the interview. In-depth one-to-one interviews were semi-structured and addressed strabismus-related symptoms and the impacts on the participants’ quality of life. Transcripts were analysed to identify themes. A self-designed questionnaire was distributed to 448 patients, 437 of whom returned valid questionnaires. Descriptive statistics and x2 test were conducted. Results Five themes were revealed regarding the impact of strabismus on patient quality of life: appearance, daily activities, personal development, social interaction, and emotions. In the survey, the top three symptoms (n ≥ 70%) rated by the participants were monocular vision, eye fatigue and physical discomfort. Compared to those without diplopia, the patients who suffered diplopia more often reported experiencing the symptoms of blurred vision, monocular vision, physical discomfort, eye fatigue, cannot estimate depth well and increasing deviation size (all p < 0.05). Conclusions This study is the first to examine quality of life among Chinese strabismus patients using both qualitative and quantitative methods and proposing a conceptual model. Symptom burden and appearance were the two original reasons for the decreased quality of life, and they were also the triggers for strabismus patients to visit clinics and undergo surgery. The interventions to treat symptoms burden should be different between patients with and without diplopia.
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Schielambulanz Graz damals und heute. SPEKTRUM DER AUGENHEILKUNDE 2017. [DOI: 10.1007/s00717-017-0355-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Merdler I, Giladi M, Sorkin N, Shapira S, Galili E, Margulis A, Korach T, Hassidim A. Strabismus and mental disorders among Israeli adolescents. J AAPOS 2017; 21:185-189. [PMID: 28433442 DOI: 10.1016/j.jaapos.2017.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/22/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the association between strabismus and mental disorders in adolescents. METHODS This case-control study included 662,641 Israeli teenagers that underwent medical evaluation by the Israel Defense Force as part of the preconscription assessment between 2005 and 2013. The association between common mental disorders (anxiety disorder, mood disorder, adjustment disorder, and attention deficit hyperactivity disorder [ADHD]) and either uncorrected strabismus or corrected strabismus was examined. The association with strabismus correction was assessed by the differences between the corrected and uncorrected groups. RESULTS The mean age at the time of the examination was 17.3 ± 0.53 years, with a male predominance (59%). A total of 1,598 subjects (0.24%) had strabismus. Of those, 952 (60%) underwent successful correction and 646 (40%) did not undergo successful correction. A significant association was found between uncorrected strabismus and anxiety disorders (OR = 1.91; 95% CI = 1.02-3.57; P = 0.047) and between corrected strabismus and ADHD (OR = 2.62; 95% CI = 1.18-5.87; P = 0.03). Strabismus correction (as assessed by comparing the uncorrected and corrected strabismus groups) was not significantly associated with the mental disorders we examined, but a nearly statistically significant association with anxiety disorder was observed (OR = 2.978; 95% CI, 1.013-8.754; P = 0.06). CONCLUSIONS The evidence from our cohort suggests that strabismus correction, even in the absence of visual impairment, is not associated with mental disorders examined in this study.
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Affiliation(s)
- Ilan Merdler
- Department of Internal Medicine H, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Moshe Giladi
- Department of Physiology and Pharmacology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nir Sorkin
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | | | - Eran Galili
- Israel Defense Force Medical Corps, Tel-Aviv, Israel; Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Alexander Margulis
- Department of Plastic and Reconstructive Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Ayal Hassidim
- Department of Plastic and Reconstructive Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Sah SP, Sharma IP, Chaudhry M, Saikia M. Health-Related Quality of Life (HRQoL) in Young Adults with Strabismus in India. J Clin Diagn Res 2017; 11:NC01-NC04. [PMID: 28384899 DOI: 10.7860/jcdr/2017/24541.9389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 11/08/2016] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Surendra P Sah
- Optometrist, Department of Optometry and Vision Science, Amity Medical School, Amity University , Gurgaon, Haryana, India
| | - Indra P Sharma
- Optometrist, Department of Optometry and Vision Science, Amity Medical School, Amity University , Gurgaon, Haryana, India
| | - Monica Chaudhry
- Professor, Department of Optometry and Vision Science, Amity Medical School, Amity University , Gurgaon, Haryana, India
| | - Mousumi Saikia
- Assistant Professor, Department of Optometry and Vision Science, Amity Medical School, Amity University , Gurgaon, Haryana, India
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Kim Y, Kim C, Kim S, Han Y, Chung I, Seo S, Park J, Yoo J. Difference of Self-identity Levels between Strabismus Patients and Normal Controls. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:410-415. [PMID: 27980359 PMCID: PMC5156614 DOI: 10.3341/kjo.2016.30.6.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/25/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate differences in self-identity in patients diagnosed with strabismus, patients who underwent strabismus surgery, and healthy control individuals. Methods Self-identity testing was done during a military service physical examination. There were three subject groups: subjects with strabismus (group 1), subjects who had undergone corrective strabismus surgery (group 2), and subjects free of strabismus (group 3). The self-identity test was comprised of six sub-sections (subjectivity, self-acceptance, future confidence, goal orientation, initiative, and familiarity). Statistical significance of the sub-sections was compared across the three groups. Correlations in age at the time of surgery and across the six sub-sections were investigated in group 2. Results A total of 351 subjects were enrolled in the study; 96 subjects were in group 1, 108 subjects were in group 2, and 147 subjects were in group 3. Significant differences were evident in subjectivity, self-acceptance, initiative and familiarity between groups 1 and 3. No significant differences were found between groups 2 and 3. In group 2, statistical significance was evident between age at surgery and initiative and familiarity (r = −0.333, p < 0.001; r = −0.433, p < 0.001, respectively). Conclusions Self-identity is greater in non-strabismus subjects than strabismus subjects. Correction of strabismus may increase self-identity levels.
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Affiliation(s)
- Youngjun Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Cheron Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seongjae Kim
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Yongseop Han
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Inyoung Chung
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Seongwook Seo
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Jongmoon Park
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
| | - Jimyong Yoo
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea.; Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea
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Xu M, Yu H, Chen Y, Xu J, Zheng J, Yu X. Long-Term Quality of Life in Adult Patients with Strabismus after Corrective Surgery Compared to the General Population. PLoS One 2016; 11:e0166418. [PMID: 27846304 PMCID: PMC5112978 DOI: 10.1371/journal.pone.0166418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/29/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the status of and factors associated with long-term health-related quality of life (HRQOL) in adult patients with strabismus following corrective surgery. METHODS Prospective cross-sectional study. A total of 122 adults who underwent corrective surgery and were followed up for at least 1 year were recruited. Pre- and post-operative HRQOL were evaluated using the Chinese version of the Adult Strabismus 20 (AS-20). Demographics and clinical characteristics were recorded. Eighty-nine age-matched, normal individuals without a history of strabismus were recruited as a control group. RESULTS AS-20 scores improved significantly in the psychosocial subscale and total scale after surgery for all122 patients, but not in the function subscale. HRQOL was better in the successful cases than in the non-successful cases (p<0.005). Subjects who recovered stereo function had better HRQOL than those who did not (p<0.01). Compared to the control population, the patients had poorer HRQOL post-operatively, with only approximately 30% of the subjects having scores within the normal threshold scores. The self-sense of a lack of ocular deviation and a successful surgical outcome were significant factors associated with post-operative HRQOL status. CONCLUSIONS HRQOL, as evaluated by AS-20 scores, improved in the patients after surgery but was worse than that in the general population. Successful surgical outcomes and a sense of good alignment were the main factors that correlated with increased post-operative HRQOL. Positive assessments of surgical results by patients may benefit post-operative HRQOL.
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Affiliation(s)
- Meiping Xu
- The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huanyun Yu
- The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuanyuan Chen
- The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinling Xu
- The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingwei Zheng
- The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinping Yu
- The Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- * E-mail:
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Shah AA, Shakoor A, Zogg CK, Oyetunji T, Ashfaq A, Garvey EM, Latif A, Riviello R, Qureshi FG, Mateen A, Haider AH, Zafar H. Influence of sub-specialty surgical care on outcomes for pediatric emergency general surgery patients in a low-middle income country. Int J Surg 2016; 29:12-8. [PMID: 26971828 DOI: 10.1016/j.ijsu.2016.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/29/2016] [Accepted: 03/06/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Whether adult general surgeons should handle pediatric emergencies is controversial. In many resource-limited settings, pediatric surgeons are not available. The study examined differences in surgical outcomes among children/adolescents managed by pediatric and adult general surgery teams for emergency general surgical (EGS) conditions at a university-hospital in South Asia. METHODS Pediatric patients (<18y) admitted with an EGS diagnosis (March 2009-April 2014) were included. Patients were dichotomized by adult vs. pediatric surgical management team. Outcome measures included: length of stay (LOS), mortality, and occurrence of ≥1 complication(s). Descriptive statistics and multivariable regression analyses with propensity scores to account for potential confounding were used to compare outcomes between the two groups. Quasi-experimental counterfactual models further examined hypothetical outcomes, assuming that all patients had been treated by pediatric surgeons. RESULTS A total of 2323 patients were included. Average age was 7.1y (±5.5 SD); most patients were male (77.7%). 1958 (84.3%) were managed by pediatric surgery. The overall probability of developing a complication was 1.8%; 0.9% died (all adult general surgery). Patients managed by adult general surgery had higher risk-adjusted odds of developing complications (OR [95%CI]: 5.42 [2.10-14.00]) and longer average LOS (7.98 vs. 5.61 days, p < 0.01). 39.8% fewer complications and an 8.2% decrease in LOS would have been expected if all patients had been managed by pediatric surgery. CONCLUSION Pediatric patients had better post-operative outcomes under pediatric surgical supervision, suggesting that, where possible in resource-constrained settings, resources should be allocated to promote development and staffing of pediatric surgical specialties parallel to adult general surgical teams.
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Affiliation(s)
- Adil A Shah
- Mayo Clinic, Division of General Surgery, Phoenix, AZ, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Surgery, Aga Khan University, Karachi, Pakistan.
| | - Amarah Shakoor
- Department of Pediatrics, West Virginia University School of Medicine, Charleston, WV, USA.
| | - Cheryl K Zogg
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | | | - Awais Ashfaq
- Mayo Clinic, Division of General Surgery, Phoenix, AZ, USA.
| | - Erin M Garvey
- Mayo Clinic, Division of General Surgery, Phoenix, AZ, USA.
| | - Asad Latif
- Department of Anesthesiology and Critical Care Medicine & Center for Global Health, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Robert Riviello
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Faisal G Qureshi
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Arif Mateen
- Department of Surgery, Aga Khan University, Karachi, Pakistan.
| | - Adil H Haider
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Hasnain Zafar
- Department of Surgery, Aga Khan University, Karachi, Pakistan.
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Tan G, Huang X, Zhang Y, Wu AH, Zhong YL, Wu K, Zhou FQ, Shao Y. A functional MRI study of altered spontaneous brain activity pattern in patients with congenital comitant strabismus using amplitude of low-frequency fluctuation. Neuropsychiatr Dis Treat 2016; 12:1243-50. [PMID: 27284244 PMCID: PMC4882152 DOI: 10.2147/ndt.s104756] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The aim of this study was to use amplitude of low-frequency fluctuation (ALFF) to investigate local features of spontaneous brain activity in patients with congenital comitant strabismus and clarify their relationship with emotional and psychosocial problems. METHODS A total of 20 patients with congenital comitant strabismus (ten males and ten females), and 20 healthy controls (ten males and ten females) closely matched in age, sex, and education underwent resting-state functional magnetic resonance imaging scans. The ALFF method was used to assess local features of spontaneous brain activity. Congenital comitant strabismus patients were distinguished from healthy controls by receiver operating characteristic curve. Correlation analysis was performed to explore the relationships between the observed mean ALFF signal values of the different areas and the Chinese version of the Hospital Anxiety and Depression Scale. RESULTS Compared with healthy controls, patients with congenital comitant strabismus had significantly lower ALFF in the bilateral medialfrontal gyrus and higher values in the bilateral cerebellum posterior lobe and left angular gyrus. In the congenital comitant strabismus group, the Hospital Anxiety and Depression Scale-depression score showed a negative correlation with the ALFF signal values of the bilateral medial frontal gyrus (r=-0.550, P=0.012) and a negative correlation was noted between the mean ALFF signal values of the left angular gyrus and strabismus duration (r=-0.515, P=0.020). CONCLUSION Congenital comitant strabismus mainly involves dysfunction in the bilateral medial frontal gyrus, bilateral cerebellum posterior lobe, and left angular gyrus, which may reflect the underlying pathologic mechanism of congenital strabismus.
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Affiliation(s)
- Gang Tan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi, People's Republic of China; Department of Ophthalmology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, People's Republic of China
| | - Xin Huang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi, People's Republic of China; Department of Ophthalmology, The First People's Hospital of Jiujiang City, Jiujiang, People's Republic of China
| | - Ying Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi, People's Republic of China
| | - An-Hua Wu
- Department of Ophthalmology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, People's Republic of China
| | - Yu-Lin Zhong
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi, People's Republic of China
| | - Kai Wu
- Department of Ophthalmology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, People's Republic of China
| | - Fu-Qing Zhou
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Medical Imaging Research Institute, Nanchang, Jiangxi, People's Republic of China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Clinical Ophthalmology Institute and Oculopathy Research Centre, Nanchang, Jiangxi, People's Republic of China
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Chang MY, Velez FG, Demer JL, Isenberg SJ, Coleman AL, Pineles SL. Quality of life in adults with strabismus. Am J Ophthalmol 2015; 159:539-44.e2. [PMID: 25498355 DOI: 10.1016/j.ajo.2014.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/29/2014] [Accepted: 12/01/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess relative quality of life in patients with strabismus. DESIGN Retrospective cohort study. METHODS The 25-item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) was performed in 42 strabismic adults over the age of 50 years at a single institution. Subscale scores were compared with those of patients with other ocular diseases, including diabetic retinopathy, age-related macular degeneration (AMD), glaucoma, cataract, cytomegalovirus (CMV) retinitis, and low vision. RESULTS Median visual acuity was 20/20 (range 20/12.5-20/50), and 34 patients (81%) reported diplopia. Strabismic patients performed the same or worse on nearly all vision-related subscales than did patients with diabetic retinopathy, age-related macular degeneration, glaucoma, cataract, and CMV retinitis. Additionally, strabismic patients reported significantly worse ocular pain than all comparison groups before any surgery was performed. CONCLUSIONS Strabismus impacts quality of life through both functional and psychosocial factors. Physicians treating strabismic patients should recognize these quality-of-life issues and address them accordingly.
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Affiliation(s)
- Melinda Y Chang
- Stein Eye Institute and the Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California
| | - Federico G Velez
- Stein Eye Institute and the Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California
| | - Joseph L Demer
- Stein Eye Institute and the Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California
| | - Sherwin J Isenberg
- Stein Eye Institute and the Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California
| | - Anne L Coleman
- Stein Eye Institute and the Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California
| | - Stacy L Pineles
- Stein Eye Institute and the Department of Ophthalmology, University of California, Los Angeles, Los Angeles, California.
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Fresina M, Campos EC. A 1-Year Review of Amblyopia and Strabismus Research. Asia Pac J Ophthalmol (Phila) 2014; 3:379-87. [PMID: 26107981 DOI: 10.1097/apo.0000000000000097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This current review highlights some of the literature published in the past year from April 2013 to May 2014. DESIGN Literature Review. METHODS The present review is based on an extended search for pertinent articles on amblyopia and strabismus published during the specified period. RESULTS Many articles are often not very comparable to one another because of a lack of randomized clinical trials with most of the studies being retrospective in nature. There is often disagreement on some terminology. Typically, the definition of binocular vision is rarely related to the tests used for evaluating it. CONCLUSIONS The authors conclude that adult strabismus patients seem to gain benefits from corrective surgery not only for their ocular misalignment, but also for social anxiety levels that may be associated with improvements in their quality of life and disability levels.
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Affiliation(s)
- Michela Fresina
- From the Department of Ophthalmology, University of Bologna, Bologna, Italy
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