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Shu Q, Pang J, Liu Z, Liang X, Chen M, Tao Z, Liu Q, Guo Y, Yang X, Ding J, Chen R, Wang S, Li W, Zhai G, Xu J, Li L. Artificial Intelligence for Early Detection of Pediatric Eye Diseases Using Mobile Photos. JAMA Netw Open 2024; 7:e2425124. [PMID: 39106068 PMCID: PMC11304122 DOI: 10.1001/jamanetworkopen.2024.25124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/31/2024] [Indexed: 08/07/2024] Open
Abstract
IMPORTANCE Identifying pediatric eye diseases at an early stage is a worldwide issue. Traditional screening procedures depend on hospitals and ophthalmologists, which are expensive and time-consuming. Using artificial intelligence (AI) to assess children's eye conditions from mobile photographs could facilitate convenient and early identification of eye disorders in a home setting. OBJECTIVE To develop an AI model to identify myopia, strabismus, and ptosis using mobile photographs. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted at the Department of Ophthalmology of Shanghai Ninth People's Hospital from October 1, 2022, to September 30, 2023, and included children who were diagnosed with myopia, strabismus, or ptosis. MAIN OUTCOMES AND MEASURES A deep learning-based model was developed to identify myopia, strabismus, and ptosis. The performance of the model was assessed using sensitivity, specificity, accuracy, the area under the curve (AUC), positive predictive values (PPV), negative predictive values (NPV), positive likelihood ratios (P-LR), negative likelihood ratios (N-LR), and the F1-score. GradCAM++ was utilized to visually and analytically assess the impact of each region on the model. A sex subgroup analysis and an age subgroup analysis were performed to validate the model's generalizability. RESULTS A total of 1419 images obtained from 476 patients (225 female [47.27%]; 299 [62.82%] aged between 6 and 12 years) were used to build the model. Among them, 946 monocular images were used to identify myopia and ptosis, and 473 binocular images were used to identify strabismus. The model demonstrated good sensitivity in detecting myopia (0.84 [95% CI, 0.82-0.87]), strabismus (0.73 [95% CI, 0.70-0.77]), and ptosis (0.85 [95% CI, 0.82-0.87]). The model showed comparable performance in identifying eye disorders in both female and male children during sex subgroup analysis. There were differences in identifying eye disorders among different age subgroups. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the AI model demonstrated strong performance in accurately identifying myopia, strabismus, and ptosis using only smartphone images. These results suggest that such a model could facilitate the early detection of pediatric eye diseases in a convenient manner at home.
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Affiliation(s)
- Qin Shu
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jiali Pang
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Zijia Liu
- Institute of Image Communication and Network Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyi Liang
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Moxin Chen
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Zhuoran Tao
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Qianwen Liu
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yonglin Guo
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xuefeng Yang
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jinru Ding
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Ruiyao Chen
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Sujing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjing Li
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Guangtao Zhai
- Institute of Image Communication and Network Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Xu
- Shanghai Artificial Intelligence Laboratory, Shanghai, China
| | - Lin Li
- Department of Ophthalmology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Grudzińska E, Durajczyk M, Grudziński M, Marchewka Ł, Modrzejewska M. Usefulness Assessment of Automated Strabismus Angle Measurements Using Innovative Strabiscan Device. J Clin Med 2024; 13:1067. [PMID: 38398381 PMCID: PMC10889385 DOI: 10.3390/jcm13041067] [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: 01/07/2024] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The variability of the obtained results of manual tests assessing the angle of strabismus depends on the experience, skills, and training of the examiner. The authors hope that this new measuring device will provide a more sensitive and repeatable method for detecting small strabismus angles compared to the gold standard-PCT. The purpose of this article is to present an innovative strabismus angle demonstration device, called Strabiscan, to provide automated measurements of eye deviation and to compare the obtained results of these measurements to the traditional manual method. METHODS For patients with manifest strabismic disease (n = 30) and a group of healthy subjects (n = 30), a detailed history was taken and routine ophthalmologic examinations were performed, including best-corrected distance visual acuity, assessment of refractive error using an autorefractometer after cycloplegia, biomicroscopic evaluation of the anterior segment of the eye and evaluation of the eye fundus by indirect ophthalmoscopy. Subsequently, each patient and healthy subject was subjected to a prismatic cover-uncover test using a manual method, after which the presence of strabismus was detected and its angle assessed using a Strabiscan demonstration device. RESULTS In the control group using the Strabiscan demonstration device, small-angle latent strabismus ≤ 3DP was diagnosed in 83% of patients, while >3DP was found in 13%. In contrast, using the prismatic cover-uncover test, latent strabismus ≤ 3DP was diagnosed in only 13% of patients, and latent strabismus with an angle > 3DP was found in 13% of patients. No statistically significant differences were noted in the measurements of strabismus angles made by the different methods. CONCLUSIONS The Strabiscan demonstration device allows quick and accurate assessment of the strabismus angle. Compared to the prismatic cover-uncover test, it has a higher sensitivity for detecting low-angle latent strabismus. Measurements with the Strabiscan do not require the presence of additional assistants for the test.
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Affiliation(s)
- Ewa Grudzińska
- Second Chair and Department of Ophthalmology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (E.G.); (M.D.)
| | - Magdalena Durajczyk
- Second Chair and Department of Ophthalmology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (E.G.); (M.D.)
| | - Marek Grudziński
- Faculty of Mechanical Engineering and Mechatronics, West Pomeranian University of Technology in Szczecin, 70-310 Szczecin, Poland; (M.G.); (Ł.M.)
| | - Łukasz Marchewka
- Faculty of Mechanical Engineering and Mechatronics, West Pomeranian University of Technology in Szczecin, 70-310 Szczecin, Poland; (M.G.); (Ł.M.)
| | - Monika Modrzejewska
- Second Chair and Department of Ophthalmology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; (E.G.); (M.D.)
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Li D, Chan VF, Virgili G, Mavi S, Pundir S, Singh MK, She X, Piyasena P, Clarke M, Whitestone N, Patnaik JL, Xiao B, Cherwek DH, Negash H, O'Connor S, Prakalapakorn SG, Huang H, Wang H, Boswell M, Congdon N. Impact of Vision Impairment and Ocular Morbidity and Their Treatment on Quality of Life in Children: A Systematic Review. Ophthalmology 2024; 131:188-207. [PMID: 37696451 DOI: 10.1016/j.ophtha.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/16/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023] Open
Abstract
TOPIC This review summarizes existing evidence of the impact of vision impairment and ocular morbidity and their treatment on children's quality of life (QoL). CLINICAL RELEVANCE Myopia and strabismus are associated with reduced QoL among children. Surgical treatment of strabismus significantly improves affected children's QoL. METHODS We conducted a systematic review and meta-analysis by screening articles in any language in 9 databases published from inception through August 22, 2022, addressing the impact of vision impairment, ocular morbidity, and their treatment on QoL in children. We reported pooled standardized mean differences (SMDs) using random-effects meta-analysis models. Quality appraisal was performed using Joanna Briggs Institute and National Institutes of Health tools. This study was registered with the International Prospective Register of Systematic Reviews (identifier, CRD42021233323). RESULTS Our search identified 29 118 articles, 44 studies (0.15%) of which were included for analysis that included 32 318 participants from 14 countries between 2005 and 2022. Seventeen observational and 4 interventional studies concerned vision impairment, whereas 10 observational and 13 interventional studies described strabismus and other ocular morbidities. Twenty-one studies were included in the meta-analysis. The QoL scores did not differ between children with and without vision impairment (SMD, -1.04; 95% confidence interval [CI], -2.11 to 0.03; P = 0.06; 9 studies). Myopic children demonstrated significantly lower QoL scores than those with normal vision (SMD, -0.60; 95% CI, -1.09 to -0.11; P = 0.02; 7 studies). Children with strabismus showed a significantly lower QoL score compared with those without (SMD, -1.19; 95% CI, -1.66 to -0.73; P < 0.001; 7 studies). Strabismus surgery significantly improved QoL in children (SMD, 1.36; 95% CI, 0.48-2.23; P < 0.001; 7 studies). No randomized controlled trials (RCTs) concerning refractive error and QoL were identified. Among all included studies, 35 (79.5%) were scored as low to moderate quality; the remaining met all quality appraisal tools criteria. DISCUSSION Reduced QoL was identified in children with myopia and strabismus. Surgical correction of strabismus improves the QoL of affected children, which supports insurance coverage of strabismus surgery. Further studies, especially RCTs, investigating the impact of correction of myopia on QoL are needed. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Dongfeng Li
- Department of Ophthalmology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China; Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China; Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Ving Fai Chan
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Gianni Virgili
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Department Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Sonia Mavi
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Sheetal Pundir
- Department of Ophthalmology, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Xinshu She
- School of Medicine, Stanford University, Stanford, California
| | - Prabhath Piyasena
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | | | - Jennifer L Patnaik
- Orbis International, New York, New York; Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Baixiang Xiao
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Affiliated Eye Hospital of Nanchang University, Nanchang City, China
| | | | | | - Sara O'Connor
- Advanced Center for Eyecare Global, Bakersfield, California
| | - S Grace Prakalapakorn
- Departments of Ophthalmology and Pediatrics, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Huilan Huang
- Shandong First Medical University (Shandong Academy of Medical Science), Jinan, China
| | - Huan Wang
- Centre on China's Economy and Institutions, Stanford University, Stanford, California
| | - Matthew Boswell
- Centre on China's Economy and Institutions, Stanford University, Stanford, California
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom; Orbis International, New York, New York; Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou City, China.
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Wei C, Yang DP, Yang Y, Yang WH, Lu YM, Yu XP, Chang S. Visual and auditory attention defects in children with intermittent exotropia. Ital J Pediatr 2024; 50:17. [PMID: 38273409 PMCID: PMC10809432 DOI: 10.1186/s13052-024-01591-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/07/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Previous studies have shown that children with intermittent exotropia (IXT) have a higher rate of psychiatric abnormalities as they grow up, such as attention deficit. This study explored visual and hearing attention among children with IXT, and evaluated its association with clinical characteristics and cognitive development. METHODS Forty-nine children with a diagnosis of IXT and 29 children with traditional development were recruited. The Integrated Visual and Auditory Continuous Performance Test (IVA-CPT) was used to measure the subjects' full-scale response control quotient (FSRCQ), full-scale attention quotient (FSAQ), auditory response control quotient (ARCQ), auditory attention quotient (AAQ), visual response control quotient (VRCQ), and visual attention quotient (VAQ). The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) was used to assess their cognitive function. The differences between the scores of children with IXT and normal controls were analyzed. RESULTS The results showed that the FSRCQ, FSAQ, ARCQ, AAQ, VRCQ, and VAQ of children with IXT were all lower than those of normal controls with the same age (P < 0.05). The level of attention was significantly correlated with the age of strabismus onset (P < 0.05), but not with the degree of strabismus, stereopsis, or fusion control score. In addition, audiovisual attention was correlated significantly with their cognitive development level. The random forest classifier prediction model showed that age of strabismus onset was an important predictor of attention. CONCLUSION Children with IXT have lower visual and auditory attention and control than their peers, and the age of onset of strabismus may be a major factor.
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Affiliation(s)
- Cong Wei
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, Guangdong, China
| | - Ding-Ping Yang
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yan Yang
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wen-Han Yang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Ya-Mei Lu
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, Guangdong, China
| | - Xin-Ping Yu
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China.
| | - Shuai Chang
- Zhong Shan Ophthalmological Center, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Joseph E, Ck M, Kumar R, Sebastian M, Suttle CM, Congdon N, Sethu S, Murthy GV. Prevalence of refractive errors among school-going children in a multistate study in India. Br J Ophthalmol 2023; 108:143-151. [PMID: 36562766 PMCID: PMC10804007 DOI: 10.1136/bjo-2022-322123] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
AIM Much existing data on childhood refractive error prevalence in India were gathered in local studies, many now dated. The aim of this study was to estimate the prevalence, severity and determinants of refractive errors among school-going children participating in a multistate vision screening programme across India. METHODS In this cross-sectional study, vision screening was conducted in children aged 5-18 years at schools in five states using a pocket vision screener. Refractive error was measured using retinoscopy, and subjective refraction and was defined both by spherical equivalent (SE) and spherical ametropia, as myopia ≤-0.5 diopters (D), hyperopia ≥+1.0 D and/or astigmatism as >0.5 D. Data from the eye with less refractive error were used to determine prevalence. RESULTS Among 2 240 804 children (50.9% boys, mean age 11.5 years, SD ±3.3), the prevalence of SE myopia was 1.57% (95% CI 1.54% to 1.60%) at 5-9 years, 3.13% (95% CI 3.09% to 3.16%) at 10-14 years and 4.8% (95% CI 4.73% to 4.86%) at 15-18 years. Hyperopia prevalence was 0.59% (95% CI 0.57% to 0.61%), 0.54% (95% CI 0.53% to 0.56%) and 0.39% (95% CI 0.37% to 0.41%), respectively. When defined by spherical ametropia, these values for myopia were 0.84%, 2.50% and 4.24%, and those for hyperopia were 2.11%, 2.41% and 2.07%, respectively.Myopia was associated with older age, female gender, private school attendance, urban location and state. The latter appeared to be driven by higher literacy rates. CONCLUSIONS Refractive error, especially myopia, is common in India. Differences in prevalence between states appear to be driven by literacy rates, suggesting that the burden of myopia may rise as literacy increases.
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Affiliation(s)
- Elizabeth Joseph
- Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India
| | - Meena Ck
- Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India
| | - Rahul Kumar
- Orbis India Country office, ORBIS International, Gurugram, Haryana, India
| | - Mary Sebastian
- Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India
| | | | | | - Sheeladevi Sethu
- Orbis India Country office, ORBIS International, Gurugram, Haryana, India
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Abstract
Strabismus, or misalignment of the eyes, is the most common ocular disorder in the pediatric population, affecting approximately 2%-4% of children. Strabismus leads to the disruption of binocular vision, amblyopia, social and occupational discrimination, and decreased quality of life. Although it has been recognized since ancient times that strabismus runs in families, its inheritance patterns are complex, and its precise genetic mechanisms have not yet been defined. Family, population, and twin studies all support a role of genetics in the development of strabismus. There are multiple forms of strabismus, and it is not known if they have shared genetic mechanisms or are distinct genetic disorders, which complicates studies of strabismus. Studies assuming that strabismus is a Mendelian disorder have found areas of linkage and candidate genes in particular families, but no definitive causal genes. Genome-wide association studies searching for common variation that contributes to strabismus risk have identified two risk loci and three copy number variants in white populations. Causative genes have been identified in congenital cranial dysinnervation disorders, syndromes in which eye movement is limited or paralyzed. The causative genes lead to either improper differentiation of cranial motor neurons or abnormal axon guidance. This article reviews the evidence for a genetic contribution to strabismus and the recent advances that have been made in the genetics of comitant strabismus, the most common form of strabismus.
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Affiliation(s)
- Mayra Martinez Sanchez
- Department of Ophthalmology, Boston Children’s Hospital, Boston, MA, United States
- Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Mary C. Whitman
- Department of Ophthalmology, Boston Children’s Hospital, Boston, MA, United States
- Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
- F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA, United States
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Kumar SGP, Ranpise D, Vishwakarma P, Gend PB, Chavan S, Kurian E. Social-emotional issues among children with strabismus higher than among non-strabismus children in Western India. Indian J Ophthalmol 2023; 71:2827-2834. [PMID: 37417129 PMCID: PMC10491034 DOI: 10.4103/ijo.ijo_2646_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/27/2023] [Accepted: 03/28/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose Data on social-emotional aspects among children with strabismus in India are scanty. We compared the emotional symptoms (ES), loneliness and social dissatisfaction (LSD), and self-esteem (SE) and their associated risk factors among children with and without strabismus in India. Methods A cross-sectional case-control study design was used to recruit 101 children with strabismus aged 8 to 18 years and a control group of 101 children that were age- and gender-matched. Interviews were performed using standardized scales to assess ES, LSD, and SE. Variations in the intensity of ES, LSD, and SE were assessed using multiple classification analysis (MCA). Results A total of 202 children participated in the study. The mean ES, LSD, and SE scores were 3.4 (standard deviation [SD] 1.9), 48.4 (SD 3.2), and 22.1 (SD 3.8) for the strabismus group and 1.8 (SD 1.5), 33.3 (SD 3), and 31.3 (SD 2) for the non-strabismus group, respectively. Among the strabismus group, the highest levels of mean ES, LSD, and SE scores were observed among children facing problems in performing daily tasks. Amongst the non-strabismus group, children studying at the primary level and those facing neglect had the highest mean scores. In MCA, being affected with strabismus had the highest effect on the intensity of ES, LSD, and SE with a beta (β) value of 0.223 (P = 0.016), 0.922 (P < 0.001), and 0.853 (P < 0.001). Conclusion A significantly high proportion of children with strabismus deal with elevated levels of ES, LSD problems, and low SE as compared with non-strabismus children, highlighting the need to address the poor social-emotional health of children.
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Althiabi S, AlDarrab A, Alenezi SH, Alharbi BA, Aljbreen AJ, Alsalamah GF, Alotaibi RA, Almutairi FA, Albadrani NA. Psychological and Social Challenges Parents of Children With Strabismus Face in Qassim Region, Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e36920. [PMID: 37128539 PMCID: PMC10148722 DOI: 10.7759/cureus.36920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
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.
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Chen L, Sun L, Xue C, Li S, Wang J, Shen X, Gao S, Zhou Z, Xu Y, Huang S, Li Z, Yang X, Guo Y, Zhang W. Refractive errors and ocular findings in children and adolescents with mental disorders: a retrospective study. BMC Ophthalmol 2023; 23:4. [PMID: 36597100 PMCID: PMC9808948 DOI: 10.1186/s12886-022-02704-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/24/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND An increasing prevalence of mental disorders (MDs) has been reported among children and adolescents. However, only few studies have conducted ocular examinations, including those on refractive status, in these groups of patients. Thus, the purpose of this study was to evaluate the refractive status and ocular findings in children and adolescents with MDs compared with matched controls with similar socioeconomic backgrounds. METHODS A total of 178 participants with MDs and 200 controls were recruited between April 2021 and May 2022. All the children and adolescents underwent cycloplegic or noncycloplegic autorefraction and retinoscopy, slit-lamp biomicroscopy, and dilated fundus examinations. Ocular alignment was assessed using Hirschberg, Krimsky, or prism cover tests. The prevalence of refractive errors and ocular findings was the main outcome. RESULTS Twenty-seven percent of patients with MDs and 8% of controls had ocular findings, the most common of which were conjunctivitis, keratitis, and trichiasis. For refractive status, 70% (124/178) of patients with MDs had myopia ≤-1.00 DS, and 2% (4/178) had hyperopia ≥+2.00 DS. In the control group, 70% (140/200) of patients had myopia ≤-1.00 DS, and 1% (2/200) had hyperopia ≥+2.00 DS. No differences were observed between the MD and control groups. However, the patients in the MD group (14.25±2.69 years) were significantly more susceptible to strabismus (P<0.05) and amblyopia (P<0.01) than those in the control group (13.65±3.04 years). There was a substantial difference between the two groups in the time spent on screen-based devices (P<0.001). Furthermore, mental retardation (OR=3.286, P<0.01), emotional disorders (OR=2.003, P<0.01), and adjustment disorders (OR=2.629, P<0.01) were associated with an increased risk of amblyopia. Depression (OR =1.362, P<0.01) and emotional disorders (OR=2.205, P<0.01) were associated with a higher prevalence of strabismus. CONCLUSION Ophthalmological examinations should be performed in children and adolescents with MDs because MDs are associated with a high prevalence of refractive errors and ocular diseases. Detection and intervention of ocular and refractive findings in children and adolescents with MDs are necessary and effective in alleviating the economic burden in healthcare and improving individuals' quality of life.
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Affiliation(s)
- Liping Chen
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Ling Sun
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.440287.d0000 0004 1764 5550Tianjin Anding Hospital, Tianjin, China ,grid.265021.20000 0000 9792 1228Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Caihong Xue
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Shumao Li
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Junjun Wang
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Xia Shen
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Shiyu Gao
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Zixuan Zhou
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Yuehe Xu
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Shaocun Huang
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Zhulin Li
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Xiaoyan Yang
- grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Yatu Guo
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
| | - Wei Zhang
- grid.265021.20000 0000 9792 1228Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China ,grid.412729.b0000 0004 1798 646XTianjin Eye Hospital, Tianjin, China ,grid.216938.70000 0000 9878 7032Nankai University affiliated Eye Hospital, Tianjin, China ,Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
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Cheng BT, Kim AB, Nadimpalli S, Pineles SL, Kurup SP. Association of Pediatric Strabismus and Functional Impairment: A Cross-sectional Nationwide Analysis. J Pediatr Ophthalmol Strabismus 2022:1-9. [PMID: 36102269 DOI: 10.3928/01913913-20220728-01] [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] [Indexed: 11/20/2022]
Abstract
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.].
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11
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Temeltürk RD, Koçer AM, Yaşar HH. Psychosocial Improvements in Children and Their Parents Following Strabismus Surgery. J Pediatr Ophthalmol Strabismus 2022; 59:261-268. [PMID: 35076312 DOI: 10.3928/01913913-20211130-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.].
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12
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Rohr JTD, Isaac CR, de Lima ADA, Garcia A, dos Santos PM, Tavares MCH. Study of Geometric Illusory Visual Perception – A New Perspective in the Functional Evaluation of Children With Strabismus. Front Hum Neurosci 2022; 16:769412. [PMID: 35496072 PMCID: PMC9043129 DOI: 10.3389/fnhum.2022.769412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Despite the various perceptual-motor deficits documented in strabismus, there is a paucity of studies evaluating visual illusions in patients with strabismus. The aim of this study was to examine how the illusionary perception occurs in children/adolescents (10–15 years old) with strabismus with referral for surgery to correct ocular deviations. A controlled cross-sectional study was carried out in which 45 participants with strabismus and 62 healthy volunteers aged 10–15 years were evaluated. The behavioral response to three geometric illusions [Vertical-Horizontal illusion, Müller-Lyer illusion (Bretano version) and Ponzo illusion] and respective neutral stimuli (non-illusory images) regarding the estimation of image size and response time were measured using the Method of Adjustment. To analyze the influence of secondary factors: type of ocular deviation (convergent, divergent or associated with vertical deviation); amount of eye deviation; presence of amblyopia and stereopsis, a one-way ANOVA was performed. Among the tested illusions, children with strabismus showed greater susceptibility (p = 0.006) and response time (p = 0.004) to Ponzo’s illusory images. Children with strabismus and preserved stereopsis, on the other hand, showed similar susceptibility and response time to control group patients to the Ponzo illusion (p < 0.005). Patients with amblyopia showed overcorrection in the estimate of non-illusory Ponzo images (p = 0.046). Children with horizontal ocular deviation (esotropia or exotropia) associated with vertical deviation (hypertropia, DVD and/or alphabetical anisotropy) showed higher susceptibility to vertical adjustment images for the Müller-Lyer illusion (Brentano version) (p = 0.017). Individuals with strabismus tended to overcorrect the length of the straight-line segment adjusted for non-illusory images when testing non-illusory images in the Müller-Lyer test (Brentano version) (p = 0.009), as well as for the neutral images in the Vertical-Horizontal test (p = 0.000). The findings indicated impairment in the perception of geometric illusions and neutral figures, especially for the Ponzo illusion test by children with strabismus. As the behavioral response to illusory images may indirectly reflect the visual and morphofunctional alterations present in these individuals, we suggest that the investigation of visual illusory perception can be used as a new research strategy in the field of investigating the visual function in strabismus.
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Affiliation(s)
- Juliana Tessari Dias Rohr
- Department of Ophthalmology, Hospital de Base do Distrito Federal, Brasília, Brazil
- Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília – UnB, Brasília, Brazil
- *Correspondence: Juliana Tessari Dias Rohr, ,
| | | | | | - Ana Garcia
- Department of Physiological Sciences, Institute of Biological Sciences, University of Brasília – UnB, Brasília, Brazil
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13
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Lee YH, Repka MX, Borlik MF, Velez FG, Perez C, Yu F, Coleman AL, Pineles SL. Association of Strabismus With Mood Disorders, Schizophrenia, and Anxiety Disorders Among Children. JAMA Ophthalmol 2022; 140:373-381. [PMID: 35266979 PMCID: PMC8914883 DOI: 10.1001/jamaophthalmol.2022.0137] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance Children with strabismus have poorer functional vision and decreased quality of life than those without strabismus. Objective To evaluate the association between strabismus and mental illness among children. Design, Setting, and Participants This cross-sectional study analyzed claims data from the OptumLabs Data Warehouse, a longitudinal deidentified commercial insurance claims database, from 12 005 189 patients enrolled in the health plan between January 1, 2007, and December 31, 2017. Eligibility criteria included age younger than 19 years at the time of strabismus diagnosis, enrollment in the health plan between 2007 and 2018, and having at least 1 strabismus claim based on International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification codes. Controls were children in the same database with no eye disease codes other than refractive error reported. Demographic characteristics and mental illness claims were compared. Statistical analysis was conducted from December 1, 2018, to July 31, 2021. Main Outcomes and Measures Presence of mental illness claims. Results Among the 12 005 189 patients (6 095 523 boys [50.8%]; mean [SD] age, 8.0 [5.9] years) in the study, adjusted odds ratios for the association of mental illnesses with strabismus were 2.01 (95% CI, 1.99-2.04) for anxiety disorder, 1.83 (95% CI, 1.76-1.90) for schizophrenia, 1.64 (95% CI, 1.59-1.70) for bipolar disorder, 1.61 (95% CI, 1.59-1.63) for depressive disorder, and 0.99 (95% CI, 0.97-1.02) for substance use disorder. There was a moderate association between each strabismus type (esotropia, exotropia, and hypertropia) and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder; odds ratios ranged from 1.23 (95% CI, 1.17-1.29) for the association between esotropia and bipolar disorder to 2.70 (95% CI, 2.66-2.74) for the association between exotropia and anxiety disorder. Conclusions and Relevance This cross-sectional study suggests that there was a moderate association between strabismus and anxiety disorder, schizophrenia, bipolar disorder, and depressive disorder but not substance use disorder. Recognizing that these associations exist should encourage mental illness screening and treatment for patients with strabismus.
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Affiliation(s)
- Yoon H Lee
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles
| | - Michael X Repka
- Department of Ophthalmology, Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcy F Borlik
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Federico G Velez
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles.,Department of Ophthalmology, Doheny Eye Institute, University of California, Los Angeles, Los Angeles.,Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Claudia Perez
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles
| | - Fei Yu
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles.,Department of Biostatistics, University of California, Los Angeles Fielding School of Public Health, Los Angeles
| | - Anne L Coleman
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles.,Department of Epidemiology, University of California, Los Angeles Fielding School of Public Health, Los Angeles
| | - Stacy L Pineles
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles.,OptumLabs, Eden Prairie, Minnesota
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14
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High Risk for Attention-Deficit Hyperactive Disorder in Children with Strabismus: A Nationwide Cohort Study from the National Health Insurance Research Database. Life (Basel) 2021; 11:life11111139. [PMID: 34833015 PMCID: PMC8622056 DOI: 10.3390/life11111139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 01/23/2023] Open
Abstract
Strabismus is associated with amblyopia and a lower quality of life. Attention-deficit hyperactivity disorder (ADHD) is common among children and adolescents, and influences their academic, vocational, and social life. Previous studies have suggested an association between strabismus and ADHD. Using data from the Taiwan National Health Insurance Research Database between 2000 and 2010, we performed a large-scale cohort study comparing the incidence, risk factors, and severity of ADHD in children with and without strabismus. A total of 2049 patients <18 years old with newly diagnosed strabismus (esotropia: 404; exotropia: 1645) were identified, and 8196 age- and sex-matched controls without strabismus were also included. After an average of 6.5 ± 2.9 years of follow-up, the incidence of ADHD per 1000 person-years was 5.39 in the strabismus group (esotropia: 9.93; exotropia: 4.11) and 3.23 in the control group. The cumulative incidence of ADHD was significantly greater in the esotropia (hazard ratio [HR]: 2.04; 95% confidence interval [CI]:1.36-3.06; p = 0.0007) and exotropia groups (HR: 1.44; 95% CI: 1.03-2.03; p = 0.038) than in the controls. Patients with strabismus had more comorbidities than those without (p < 0.05). In summary, this large-scale study found a higher cumulative incidence of ADHD in patients with strabismus, especially in those with esotropia.
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15
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Mao D, Lin J, Chen L, Luo J, Yan J. Health-related quality of life and anxiety associated with childhood intermittent exotropia before and after surgical correction. BMC Ophthalmol 2021; 21:270. [PMID: 34193079 PMCID: PMC8247233 DOI: 10.1186/s12886-021-02027-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intermittent exotropia (IXT) is the most common form of exotropia in children. In addition to cosmetic effects and loss of stereoscopic function, IXT may negatively impact the psychological well-being of children and their parents. The purpose of this study was to assess the patient-reported outcomes of Chinese children with IXT before and after strabismus surgery. METHODS The records of children with IXT who underwent strabismus surgery at the Zhongshan Ophthalmic Center of Sun Yat-sen University, China over the period from January 1, 2016 to December 31, 2018 were prospectively recruited. All children underwent ophthalmic and orthoptic examinations, including the prism and alternate cover test, fusion function by synoptophore, stereoacuity and Newcastle control score. Two patient-reported outcome measures were used: the intermittent Exotropia Questionnaire (IXTQ) to measure disease-specific health-related quality of life (HRQOL) and the Hospital Anxiety and Depression Scale (HADS) to measure anxiety and depression. Patient-reported outcome measurements were made before and after surgery with responses from children and their parents. RESULTS A total of 389 children were eligible for inclusion (47.8% male, 52.2% female, mean + SD age = 8.17 ± 2.81). Preoperative IXTQ scores in both children (48.21 ± 26.2) and their parents (44.6 ± 25.68) were significantly correlated with near stereoacuity (P = 0.029 and P = 0.015, respectively). The angle of deviation at near vision showed a negative linear relationship with visual function (P = 0.026) and psychological (P = 0.019) scores as well as opinions regarding surgery (P = 0.024). HADS scores (anxiety scale score: 11 ± 2.92, depression scale score: 10.44 ± 2.9) were also related to near stereoacuity (P < 0.05). After surgery, both children's (74.83 ± 16.59) and parents' (68.57 ± 17.06) IXTQ scores significantly improved (p<0.01). Children's IXTQ scores were related to the angle of deviation at distance, and their psychological and visual function scores showed a negative relationship with the angle of deviation at near vision (P < 0.05). CONCLUSION Children and parents' HRQOL and HADS were associated with near stereoacuity. Parents usually attend more readily to the angle of deviation at near in their IXT children. HRQOL improved significantly after surgery and can be used as one of the indices for preoperative evaluation but is not recommended as a criterion for surgical intervention.
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Affiliation(s)
- Danyi Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Jing Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Lina Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Jiying Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Jianhua Yan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.
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16
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Venâncio TS, de Araújo BMF, Negrão JVRDT, Andrade Freire LD, Kasahara N. The impact of monocular and binocular visual impairment on the quality of life of Brazilian children. BRITISH JOURNAL OF VISUAL IMPAIRMENT 2021. [DOI: 10.1177/0264619621994882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this case–control study was to assess the quality of life (QoL) in children with visual impairment from an urban area in Brazil. Participants included children with binocular and monocular visual impairment and normal controls aged between 4 and 15 years. All subjects underwent a basic ophthalmic exam and answered the Pediatric Quality of Life Inventory™ (PedsQL). The score results were compared among the groups with analysis of variance (ANOVA). The sample included 45 children with visual disability (24 binocular and 21 monocular) and 30 age-matched controls. The groups did not differ in age and gender distribution. The child self-report score for the binocular visual impairment group was lower when compared to controls in all four core scales; as compared to monocular children, the binocular group scored lower in physical health and social functioning. The total score of binocular children (67.9 ± 25.2) was lower than that for monocular children (83.0 ± 13.3, p = .01) and controls (84.2 ± 13.6, p < .001). Children with monocular visual disability presented very similar scores to controls in both self-reported and parent proxy inventory (81.6 ± 15.2, p = .97 and 81.9 ± 15.3, p = .99, respectively). These data should help governments develop public health interventions and rehabilitation strategies for visually disabled children.
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Affiliation(s)
| | | | | | | | - Niro Kasahara
- Irmandade da Santa Casa de Misericórdia de Sao Paulo, Sao Paulo, Brazil; Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, Brazil
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17
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Hatt SR, Leske DA, Castañeda YS, Wernimont SM, Liebermann L, Cheng-Patel CS, Birch EE, Holmes JM. Association of Strabismus With Functional Vision and Eye-Related Quality of Life in Children. JAMA Ophthalmol 2021; 138:528-535. [PMID: 32215586 DOI: 10.1001/jamaophthalmol.2020.0539] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Strabismus is common, affecting 2% to 4% of children, but how children and their families are affected in everyday life is poorly understood. Objective To evaluate the association of strabismus with functional vision and eye-related quality of life in children and their families using the Pediatric Eye Questionnaire (PedEyeQ). Design, Setting, and Participants This cross-sectional study was conducted between December 2017 and October 2019 and included 91 children with strabismus and 166 visually normal controls across 3 age groups (0-4, 5-11, and 12-17 years) who were enrolled at Mayo Clinic, Rochester, Minnesota, and Retina Foundation of the Southwest, Dallas, Texas. Exposures Children completed the child PedEyeQ (5 to 11- and 12 to 17-year versions: functional vision, bothered by eyes/vision, social, and frustration/worry domains); parents completed the proxy (0 to 4-, 5 to 11-, and 12 to 17-year versions: functional vision, bothered by eyes/vision, social, frustration/worry, and eye care domains) and the parent PedEyeQ (impact on parent and family, worry about child's eye condition, worry about child's self-perception and interactions, and worry about child's functional vision domains). Rasch-calibrated PedEyeQ scores were calculated for each domain and converted to 0 (worst) to 100. Main Outcomes and Measures PedEyeQ domain scores. Results Of 91 participants with strabismus, 41 (45.1%) were girls, 74 (81.3%) were white, 4 (4.4%) were Asian, 5 (5.5%) were more than 1 race, 5 (5.5%) were African American, and 2 (2.2%) were American Indian/Alaska Native. Child PedEyeQ domain scores were lower with strabismus vs visually normal controls among children ages 5 to 11 years and the greatest mean (SD) difference was in functional vision (12 [14] points; 95% CI, 6-18; P = .001), and among children ages 12 to 17 years, the greatest mean (SD) difference was in frustration/worry (27 [13] points; 95% CI, 18-36; P < .001). Proxy PedEyeQ domain scores were also lower with strabismus. The greatest difference among children ages 0 to 4 years was in functional vision (13 [9] points; 95% CI, 9-16; P < .001), among children ages 5 to 11 years was in functional vision (26 [10] points; 95% CI, 22-30; P < .001); and among children ages 12 to 17 years was in functional vision (21 [12] points; 95% CI, 12-30; P < .001), social (21 [13] points; 95% CI, 12-30; P < .001), and frustration/worry (21 [13] points; 95% CI, 12-30; P < .001). Parent PedEyeQ domain scores were lower with strabismus; the greatest difference was in worry about child's eye condition (38 [14] points; 95% CI, 34-42; P < .001). Conclusions and Relevance Strabismus is associated with reduced functional vision and eye-related quality of life in children. Parents of children with strabismus also experience a reduced quality of life. These findings advance our understanding of how strabismus affects children and their families and should be considered when defining patient management goals.
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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
| | | | | | | | | | - Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas.,Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas
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18
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Morita Y, Hiraoka T, Oshika T. Influence of intermittent exotropia surgery on general health-related quality of life: different perception by children and parents. Jpn J Ophthalmol 2021; 65:326-330. [PMID: 33423137 DOI: 10.1007/s10384-020-00811-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the general health-related quality of life (QOL) in children with intermittent exotropia (IXT) before and 3 months after surgery, by interviewing individual patients and their parents. STUDY DESIGN Prospective, interventional case series. METHODS Twenty-one patients undergoing IXT surgery and their parents were included. Using the Pediatric Quality of Life Inventory (PedsQL), children and parents were separately questioned about QOL of patients. RESULTS The mean patients' age was 8.6 ± 3.2 years (SD), with range of 5-16 years. The children responded that all PedsQL scores were significantly improved by surgery, and the highest improvement was observed in the school subscale score. When the parents rated the children's QOL, significant improvements were limited to 3 out of 7 subscales, including the emotional, psychosocial health summary, and total scores. The improvements in the PedsQL score were not correlated with age, size of deviation changes following surgery, nor the improvement in binocular vision. CONCLUSIONS The general health-related QOL significantly improved by surgery in pediatric patients with IXT, while the improvement was considerably underestimated by the parents. The children reported the greatest improvement in the school functioning subscale, whereas parents failed to discern this improvement. The discrepancy in children' and parents' views can be an important factor when considering indication of corrective surgery and evaluating surgical outcomes.
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Affiliation(s)
- Yuka Morita
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takahiro Hiraoka
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tetsuro Oshika
- Department of Ophthalmology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki, 305-8575, Japan.
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Prevalence of Strabismus and Its Impact on Vision-Related Quality of Life. Ophthalmology 2020; 127:1113-1122. [DOI: 10.1016/j.ophtha.2020.02.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/23/2019] [Accepted: 02/20/2020] [Indexed: 12/20/2022] Open
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Burgos-Blasco B, Hernández-García E, Morales Fernández L, Gómez-de-Liaño R. Satisfaction with strabismus surgery based on the opinion of expert surgeons. ACTA ACUST UNITED AC 2020; 96:19-25. [PMID: 32709474 DOI: 10.1016/j.oftal.2020.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the perception of strabismus surgeons in Spain regarding patient satisfaction after surgery, by analysing the types of strabismus with the most satisfied patients, as well as the causes of dissatisfaction. METHODS A survey was carried out among the members of the Spanish Strabology Society who were over 50 years of age, active in Spain, with more than 20 years of surgical experience, and whose main surgical activity was strabismus. The questionnaire consisted of 18 questions about the perception of patient satisfaction according to the type of strabismus, patient age, as well as the most frequent cause of dissatisfaction after surgery. RESULTS The questionnaires were completed by a total of 29 surgeons, with a mean of 31 years of surgical experience. The most frequent cause of perceived dissatisfaction was residual strabismus. No differences were found in the satisfaction index between children and adults. The surgery that was considered to produce greater satisfaction was endotropia, followed by decompensated 4th nerve palsy, and exotropia, while 3rd nerve palsy was the cause of the most dissatisfaction. CONCLUSIONS According to strabismus surgeons, endotropia is the most satisfactory surgery for the patient, followed by exotropia, vertical strabismus, and traumatic paralysis of the 4th cranial nerve.
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Affiliation(s)
- B Burgos-Blasco
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.
| | - E Hernández-García
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - L Morales Fernández
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - R Gómez-de-Liaño
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
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