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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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Silva N, Castro C, Caiado F, Maia S, Miranda V, Parreira R, Menéres P. Evaluation of Functional Vision and Eye-Related Quality of Life in Children with Strabismus. Clin Ophthalmol 2022; 16:803-813. [PMID: 35321043 PMCID: PMC8934867 DOI: 10.2147/opth.s354835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Nisa Silva
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Correspondence: Nisa Silva, Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, Porto, 4099-001, Portugal, Tel +35 1918367661, Fax +35 1222077500, Email
| | - Catarina Castro
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Filipa Caiado
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Sofia Maia
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Vasco Miranda
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
| | - Ricardo Parreira
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Pedro Menéres
- Department of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
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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: 2] [Impact Index Per Article: 0.7] [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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Paduca A, Arnaut O, Beschieru E, Lundmark PO, Bruenech JR. Shared decision making and patients satisfaction with strabismus care-a pilot study. BMC Med Inform Decis Mak 2021; 21:109. [PMID: 33771137 PMCID: PMC7995717 DOI: 10.1186/s12911-021-01469-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strabismus is a complex disease that has various treatment approaches each with its own advantages and drawbacks. In this context, shared decisions making (SDM) is a communication process with the provider sharing all the relevant treatment alternatives, all the benefits, and risks of each procedure, while the patient shares all the preferences and values regarding his/her choices. In that way, SDM is a bidirectional process that goes beyond the typical informed consent. Therefore, it is known a little of the extent to which SDM influences the satisfaction with the treatment outcome along with strabismus patients. To study this correlation, an SDM-Q-9 questionnaire was provided within surgical consultations where treatment decisions were made; the SDM-Q-9 aims to assess the relationship between the post-operative patient's satisfaction and their SMD score. METHODS The study is considered a prospective observational pilot study. Eligible patients were adult patients diagnosed with strabismus, who had multiple treatment options, were given at the right of choice without being driven into a physician's preference. Ninety-three strabismus patients were asked to fill out the SDM-Q-9 questionnaire related to their perception of SDM during the entire period of strabismus treatment. After the treatment, patients were asked to rate their satisfaction level with the surgical outcome as excellent, good, fair, and poor. Descriptive statistics and the linear regression statistical tests (Spearman, Mann Whitney U, and Kriskal-Wallis) were used as analysis tools. RESULTS The average age of the participants was 24, where 50.6% were women. The mean SDM-Q-9 score among patients was 32 (IQR = 3). The postoperative patient satisfaction was rated as being excellent by 16 (17.2%) patients, good by 38 (40.9%), fair by 32 (34.4%), and poor by 7 patients (7.5%). Data analysis by linear regression statistical tests showed a positive correlation between the SDM-Q-9 score and the patient satisfaction related to the surgery outcome (B = 0.005, p < 0.001). Criteria in assessing patients' satisfaction were age, gender, and strabismus type. A positive correlation between SDM and real satisfaction (r = 0.834, p < 0.01) was found with age, and no significant relationship was found while taking into consideration the responder's gender and the strabismus type. CONCLUSIONS Assessing patient satisfaction after choosing a treatment for strabismus method helped us evaluate the gaps in constructive dialogue that would lead to a positive outcome for both patient and clinician. The correlation between the SDM process and the patients' satisfaction with surgery outcome, adjusted by age, has been established. These findings can serve as a springboard to further communicative improvements related to the SDM process and between patients and physicians, thereby consequently leading to patients' satisfaction raise in strabismus care. The study underlines the importance of further analysis and validation of on-ground interactions among the adolescent and adult patients and the clinicians across the strabismus management trajectory. A multicentral study and its validation will follow.
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Affiliation(s)
- Ala Paduca
- Faculty of Health and Social Science, South Eastern University Norway, Kongsberg, Norway. .,Ophthalmology Department, Universitatea de Stat de Medicina si Farmacie "Nicolae Testemitanu″, Chişinău, Republic of Moldova.
| | - Oleg Arnaut
- Department of Human Physiology and Biophysics, Universitatea de Stat de Medicina si Farmacie "Nicolae Testemitanu", Chişinău, Republic of Moldova
| | - Eugeniu Beschieru
- Department of Surgery No.1 "N. Anestiadi", Universitatea de Stat de Medicina si Farmacie "Nicolae Testemitanu", Chişinău, Republic of Moldova
| | - Per Olof Lundmark
- Faculty of Health and Social Science, South Eastern University Norway, Kongsberg, Norway
| | - Jan Richard Bruenech
- Faculty of Health and Social Science, South Eastern University Norway, Kongsberg, Norway
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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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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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Valente TLA, de Almeida JDS, Silva AC, Teixeira JAM, Gattass M. Automatic diagnosis of strabismus in digital videos through cover test. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2017; 140:295-305. [PMID: 28254087 DOI: 10.1016/j.cmpb.2017.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 12/29/2016] [Accepted: 01/03/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Medical image processing can contribute to the detection and diagnosis of human body anomalies, and it represents an important tool to assist in minimizing the degree of uncertainty of any diagnosis, while providing specialists with an additional source of diagnostic information. Strabismus is an anomaly that affects approximately 4% of the population. Strabismus modifies vision such that the eyes do not properly align, influencing binocular vision and depth perception. Additionally, it results in aesthetic problems, which can be reversed at any age. However, the use of low cost computational resources to assist in the diagnosis and treatment of strabismus is not yet widely available. This work presents a computational methodology to automatically diagnose strabismus through digital videos featuring a cover test using only a workstation computer to process these videos. METHODS The method proposed was validated in patients with exotropia and consists of eight steps: (1) acquisition, (2) detection of the region surrounding the eyes, (3) identification of the location of the pupil, (4) identification of the location of the limbus, (5) eye movement tracking, (6) detection of the occluder, (7) identification of evidence of the presence of strabismus, and (8) diagnosis. RESULTS To detect the presence of strabismus, the proposed method achieved a specificity value of 100%, and (2) a sensitivity value of 80%, with 93.33% accuracy in diagnosis of patients with extropia. This procedure was recognized to diagnose strabismus with an accuracy value of 87%, while acknowledging measures lower than 1Δ, and an average error in the deviation measure of 2.57Δ. CONCLUSIONS We demonstrated the feasibility of using computational resources based on image processing techniques to achieve success in diagnosing strabismus by using the cover test. Despite the promising results the proposed method must be validated in a greater volume of video including other types of strabismus.
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Affiliation(s)
- Thales Levi Azevedo Valente
- Federal University of Maranhão - UFMA, Applied Computing Group - NCA/UFMA, Av. dos Portugueses, SN, Campus do Bacanga, Bacanga 65085-580, São Luís, MA, Brazil.
| | - João Dallyson Sousa de Almeida
- Federal University of Maranhão - UFMA, Applied Computing Group - NCA/UFMA, Av. dos Portugueses, SN, Campus do Bacanga, Bacanga 65085-580, São Luís, MA, Brazil.
| | - Aristófanes Corrêa Silva
- Federal University of Maranhão - UFMA, Applied Computing Group - NCA/UFMA, Av. dos Portugueses, SN, Campus do Bacanga, Bacanga 65085-580, São Luís, MA, Brazil.
| | - Jorge Antonio Meireles Teixeira
- Federal University of Maranhão - UFMA, Applied Computing Group - NCA/UFMA, Av. dos Portugueses, SN, Campus do Bacanga, Bacanga 65085-580, São Luís, MA, Brazil.
| | - Marcelo Gattass
- Pontifical Catholic University of Rio de Janeiro - PUC-Rio, R. São Vicente, 225, Gávea, 22453-900, Rio de Janeiro, RJ, Brazil.
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Altiaylik Ozer P, Kabatas EU, Kucuk Bicer B, Bodur S, Kurtul BE. Does Correction of Strabismus Improve Quality of Life in Children with Autism Spectrum Disorder: Results of a Parent Survey by Ophthalmologists. Semin Ophthalmol 2016; 33:149-154. [PMID: 27599387 DOI: 10.1080/08820538.2016.1182559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Ophthalmic problems are reported to be common in children with autism spectrum disorder (ASD), and strabismus is of particular importance. We aimed to investigate the outcomes of strabismus management in cases with ASD and identify the impact of optical or surgical correction of the strabismus on the child using a questionnaire for parents. METHODS A survey was designed to assess parents' perceptions of pre-management and post-management quality of life in 41 children aged 5-17 years with ASD and strabismus using a questionnaire with 10 questions, including three subscales. RESULTS Significant improvements were noted after management in functional limitations (P < 0.01), psychosocial interactions (P < 0.01), and ocular alignment (P < 0.01) subscales. CONCLUSION This is the first study of the literature that investigated the impact of ocular re-alignment on behavioral patterns and social interactions of children with ASD and strabismus.
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Affiliation(s)
- Pinar Altiaylik Ozer
- a Department of Ophthalmology, Ministry of Health , Dr. Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey
| | - Emrah Utku Kabatas
- a Department of Ophthalmology, Ministry of Health , Dr. Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey
| | - Burcu Kucuk Bicer
- b Department of Public Health , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Sahin Bodur
- c Department of Child Psychiatry, Ministry of Health , Dr. Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey
| | - Bengi Ece Kurtul
- a Department of Ophthalmology, Ministry of Health , Dr. Sami Ulus Maternity and Children Research and Training Hospital , Ankara , Turkey
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Wang X, Gao X, Xiao M, Tang L, Wei X, Zeng J, Li Y. Effectiveness of strabismus surgery on the health-related quality of life assessment of children with intermittent exotropia and their parents: a randomized clinical trial. J AAPOS 2015; 19:298-303. [PMID: 26235788 DOI: 10.1016/j.jaapos.2015.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 02/13/2015] [Accepted: 04/05/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the ability of strabismus surgery to improve the health-related quality of life (HRQOL) assessment scores of children with intermittent exotropia and their parents. METHODS For this prospective, randomized, parallel group study, 130 children (8-17 year of age) with intermittent exotropia were recruited and randomized to undergo either corrective strabismus surgery or active monitoring without surgery. Each child was accompanied by a parent. HRQOL was assessed with 3 intermittent exotropia questionnaires (IXTQ)--the child self-report, parental proxy report, and parental self-report--administered at enrollment and 3 months after intervention. The primary outcome was change in IXTQ score after 3 months for both groups. RESULTS At enrollment the scores of the surgery group (n = 63) and monitoring group (n = 57) did not differ significantly (P > 0.05). The sex of the reporting parent had no significant influence on the proxy or parental scores at enrollment or at 3 months (P > 0.05, multivariate analysis). Strabismus surgery significantly improved all parts of the IXTQ scores (P < 0.0001, repeated measures analysis of variance). No significant changes were found for the child scores at 3 months in the monitoring group (P = 0.33). However, the parental and proxy scores were significantly decreased (P < 0.0001). CONCLUSIONS Corrective strabismus surgery significantly improved the HRQOL scores of the children with intermittent exotropia and their parents.
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Affiliation(s)
- Xiang Wang
- Cancer Research Institute, Central South University, Changsha, Hunan, China; Department of Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xueping Gao
- Medical Psychological Institute, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Manyi Xiao
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Luosheng Tang
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xin Wei
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiexi Zeng
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yunping Li
- Department of Ophthalmology, Second Xiangya Hospital, Central South University, Changsha, Hunan, China; State Key Laboratory of Medical Genetics, Central South University, Changsha, Hunan, China; Eye Research Institute, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Mehta VJ, Utz VM, Traboulsi EI, Rychwalski P. Outcomes of Strabismus Surgery with or without Trainee Participation as Surgeon. Ophthalmology 2014; 121:2066-9. [DOI: 10.1016/j.ophtha.2014.04.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 02/28/2014] [Accepted: 04/22/2014] [Indexed: 11/30/2022] Open
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Buck D, McColl E, Powell CJ, Shen J, Sloper J, Steen N, Taylor R, Tiffin P, Vale L, Clarke MP. Surgery versus Active Monitoring in Intermittent Exotropia (SamExo): study protocol for a pilot randomised controlled trial. Trials 2012; 13:192. [PMID: 23072556 PMCID: PMC3521171 DOI: 10.1186/1745-6215-13-192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 09/26/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood intermittent exotropia [X(T)] is a type of strabismus (squint) in which one eye deviates outward at times, usually when the child is tired. It may progress to a permanent squint, loss of stereovision and/or amblyopia (reduced vision). Treatment options for X(T) include eye patches, glasses, surgery and active monitoring. There is no consensus regarding how this condition should be managed, and even when surgery is the preferred option clinicians disagree as to the optimal timing. Reports on the natural history of X(T) are limited, and there is no randomised controlled trial (RCT) evidence on the effectiveness or efficiency of surgery compared with active monitoring. The SamExo (Surgery versus Active Monitoring in Intermittent Exotropia) pilot study has been designed to test the feasibility of such a trial in the UK. METHODS DESIGN an external pilot patient randomised controlled trial. SETTING four UK secondary ophthalmology care facilities at Newcastle NHS Hospitals Foundation Trust, Sunderland Eye Infirmary, Moorfields Eye Hospital and York NHS Trust. PARTICIPANTS children aged between 6 months and 16 years referred with suspected and subsequently diagnosed X(T). Recruitment target is a total of 144 children over a 9-month period, with 120 retained by 9-month outcome visit.Randomisation: permuted blocks stratified by collaborating centre, age and severity of X(T). INTERVENTIONS initial clinical assessment; randomisation (eye muscle surgery or active monitoring); 3-, 6- and 9-month (primary outcome) clinical assessments; participant/proxy completed questionnaire covering time and travel costs, health services use and quality of life (Intermittent Exotropia Questionnaire); qualitative interviews with parents to establish reasons for agreeing or declining participation in the pilot trial. OUTCOMES recruitment and retention rates; nature and extent of participation bias; nature and extent of biases arising from crossover or loss to follow-up; reasons for agreeing/declining participation; variability of cure rates (to inform power calculations for a definitive RCT); completion rates of outcome measures. DISCUSSION The SamExo pilot trial will provide important pointers regarding the feasibility of a full RCT of immediate surgery versus deferred surgery/active monitoring. The results of this pilot, including differences in cure rates, will inform the design of a definitive RCT. TRIAL REGISTRATION ISRCTN44114892.
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Affiliation(s)
- Deborah Buck
- Institute of Neuroscience, c/o Clinical Trials Unit, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Christine J Powell
- Royal Victoria Infirmary Eye Department, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
| | - Jing Shen
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | | | - Nick Steen
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Luke Vale
- Institute of Health & Society, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne, UK
| | - Michael P Clarke
- Royal Victoria Infirmary Eye Department, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
- Institute of Neuroscience, Medical School, Newcastle University, Newcastle upon Tyne, UK
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Chung SA, Chang YH, Rhiu S, Lew H, Lee JB. Parent-reported symptoms of attention deficit hyperactivity disorder in children with intermittent exotropia before and after strabismus surgery. Yonsei Med J 2012; 53:806-11. [PMID: 22665350 PMCID: PMC3381481 DOI: 10.3349/ymj.2012.53.4.806] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To investigate the symptoms of attention deficit hyperactivity disorder (ADHD) as reported by parents in children with intermittent exotropia [X(T)] and to determine whether strabismus surgery for X(T) affects ADHD symptoms. MATERIALS AND METHODS Fifty-one consecutive children undergoing muscle surgery for X(T) were prospectively recruited. One parent of each child completed the ADHD rating scale IV (ADHD RS-IV) assessment consecutively before and one year after surgery. Patients whose preoperative scores were above the cut-off point, the 90th percentile based on a Korean sample, were regarded as demonstrating the ADHD trait. The impact of muscle surgery on ADHD symptoms was assessed by comparing the preoperative scores with the post-operative scores. RESULTS Eight (15.7%) of the 51 patients demonstrated the ADHD trait. ADHD RS-IV scores following strabismus surgery significantly decreased in patients with the ADHD trait (p=0.014), while they did not differ in patients without the ADHD trait. Seven (87.5%) of the 8 patients with the ADHD trait showed improvement in their ADHD RS-IV scores after surgery. There was no difference in surgical success rates between X(T) patients with and without the ADHD trait. CONCLUSION The ADHD trait was relatively common in children with X(T), and the parent-reported symptoms of the children with the ADHD trait improved after strabismus surgery. These results suggest that childhood X(T) may be one contributing factor to ADHD- related symptoms.
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Affiliation(s)
- Seung Ah Chung
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Chang
- Department of Ophthalmology, Ajou University School of Medicine, Suwon, Korea
| | - Soolienah Rhiu
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Helen Lew
- Department of Ophthalmology, CHA University College of Medicine, Bundang CHA Hospital, Seongnam, Korea
| | - Jong Bok Lee
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
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Xu J, Yu X, Huang Y, Chen J, Yu H, Wang Y, Zhang F. The psychosocial effects of strabismus before and after surgical correction in Chinese adolescents and adults. J Pediatr Ophthalmol Strabismus 2012; 49:170-5. [PMID: 22909123 DOI: 10.3928/01913913-20110920-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 08/31/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the psychosocial problems associated with strabismus and the effects of corrective surgery in Chinese adolescents and adults with strabismus. METHODS Psychosocial function was assessed by using a self-response questionnaire administered before and after corrective surgery. The self-response questionnaire was constructed based on previous studies and clinical experience of the authors. RESULTS Many of the 56 included patients had some psychosocial problems. Improvement in self-confidence, self-esteem, and relationships with friends was reported after surgery. CONCLUSION Chinese adolescents and adults with strabismus have low self-confidence and self-esteem, and experience difficulties in interacting in social situations. Corrective surgery improves psychosocial function.
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Affiliation(s)
- Jinling Xu
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical College, Wenzhou, Zhejiang, China
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14
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Abstract
PURPOSE The purpose of this study was to determine whether an equal amount of exotropia (XT) or esotropia (ET) produces a more noticeable eye turn, which gives the better impression of eye contact, and how a positive angle kappa (K) affects this judgment. METHODS Images from a white male model were manipulated to simulate 0, 5, 10, and 15° of ET and XT for both 0 and +5° K. A series of image pairs was then created that juxtaposed XT and ET of equal angles for both 0 and +5° K. Forty-five optometry students then judged which image in each pair appeared to have the greater tropia and which gave the greater impression of eye contact. RESULTS When angle kappa was 0, there was no significant difference in whether XT or ET appeared to be more noticeable. However, when angle kappa was +5°, an XT of 5° or greater became more apparent than an equal ET (p < 0.001). However, when the criterion was eye contact, ET gave the greater impression that eye contact was being made when the deviation was 10° or more, and this was true for both 0 and +5° K (p < 0.001). CONCLUSIONS When a strabismus is to be evaluated or corrected purely for cosmetic reasons, the results may differ depending on the value of angle kappa and whether the criterion for good cosmesis is ocular deviation or eye contact.
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Gogate PM, Rishikeshi N, Taras S, Aghor M, Deshpande MD. Clinical audit of horizontal strabismus surgery in children in Maharashtra, India. Strabismus 2010; 18:13-7. [PMID: 20230201 DOI: 10.3109/09273970903567618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The study aimed to audit the results of horizontal strabismus surgery in the hospital's pediatric ophthalmology department in Maharashtra, India. METHOD Medical records of strabismus surgeries done over 3 years were collated. Preoperative visual acuity, deviation, refraction, and orthoptic evaluation were noted as well as post-operative residual deviation and patient satisfaction. Post-operative residual deviation < or = 10Delta was considered good outcome, 11-20Delta borderline, and > 20Delta was considered poor outcome. The surgeons were briefed about their results periodically and the cause of poor outcomes discussed. RESULT Between March 2004 and December 2007, 529 children were operated upon, of whom 461 (87.1%) completed the 6-week follow-up. Average age was 9 years 7 months (range 1-19 years). 260/461 (56.3%) patients had good, 100/461 (21.6%) borderline, and 101/461 (21.9%) had poor outcome. 133/231 (57.6%) cases of esotropia and 127/230 (55.2%) cases of exotropia had a good outcome, while the poor outcome was 50/231 (21.6%) and 51/230 (22.1%), respectively. Bilateral medial rectus recession for esotropia had 25/56 (44.6%) good outcome and 15/56 (26.7%) poor outcome, while recess-resect procedures (R/R) for esotropia had 108/175 (61.7%) good and 35/175 (20%) poor outcome (p = 0.062). Bilateral lateral rectus recession for exotropia had 30/56 (53.6%) good and 12/56 (21.4%) had poor outcome, while for recess-resect procedures for exotropia it was 97/174 (55.7%) good and 39/174 (22.4%) poor outcome (p = 0.97). The result did not significantly change over 3 years. 433/461 (93.9%) expressed satisfaction about the surgery on 6-week follow-up. Large pre-operative deviations and amblyopic eyes accounted for 63/101 (62.3%) cases of poor outcome. Fifty-seven patients recorded an improvement in stereopsis. CONCLUSION Recess-resect procedures had better outcome as compared to bilateral recess procedures, but it was not statistically significant. Clinical audit helped maintain and improve good outcome over the 3 years.
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16
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Tukkers-van Aalst FS, Rensen CS, de Graaf ME, van Nieuwenhuizen O, Wittebol-Post D. Assessment of psychomotor development before and after strabismus surgery for infantile esotropia. J Pediatr Ophthalmol Strabismus 2007; 44:350-5; quiz 372-3. [PMID: 18062493 DOI: 10.3928/01913913-20071101-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess motor and mental development before and after strabismus surgery in children with infantile esotropia. PATIENTS AND METHODS Mental and motor development indexes of 20 children with infantile esotropia without neurologic abnormalities and 17 age-matched healthy control subjects were prospectively tested at regular intervals before and after strabismus surgery with the Dutch version of the Bayley and ordinal scales of infant development. RESULTS The mean age for surgery in the study group was 13.5 months. Before strabismus surgery, the Bayley scales of infant development showed a significant delay in both mental (P < .045) and motor (P < .008) development for children with infantile esotropia compared with the control group. Three weeks after surgery, the delay in mental development had disappeared. The delay in motor development persisted for months. Two of the 7 ordinal scales--object permanence (P < .01) and means-end (P < .036)--showed a statistically significant delay for children with infantile esotropia. Three weeks after strabismus surgery, there was no difference between the study group and the control group. CONCLUSIONS Children with infantile esotropia had delayed motor and mental development compared with healthy children. After strabismus surgery, patients recovered mentally, but their motor delays persisted for months when tested with the Bayley scales of infant development.
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17
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Rajak SN, Currie ADM, Dubois VJP, Morris M, Vickers S. Tinted contact lenses as an alternative management for photophobia in stationary cone dystrophies in children. J AAPOS 2006; 10:336-9. [PMID: 16935234 DOI: 10.1016/j.jaapos.2006.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Accepted: 12/27/2005] [Indexed: 11/21/2022]
Abstract
BACKGROUND Intense photophobia is a debilitating symptom of the stationary cone dystrophies. The dark-tinted glasses with side-shields and floppy hats used to manage this are very conspicuous and can cause marked psychological morbidity to the children and their families. We assess the use of tinted contact lenses as an alternative management for the photophobia. METHODS Three children, aged 5 to 13, with cone dystrophies, all with markedly reduced visual acuity, color vision, and profound photophobia were fitted with Lunelle ES70 Solaire 70% brown contact lenses. The child's parents completed two Children's Visual Function Questionnaires, the first pertaining to the period when the child wore tinted glasses; the second pertaining to the period of tinted contact lens wear. RESULTS Subjectively, two of the children and their parents described a striking improvement in their quality of life, with improved confidence, interactions with other children, and cessation of name-calling and bullying. The Children's Visual Function Questionnaires gave objective evidence for this improvement in one child and was not significantly different in the other. The third child was reluctant to wear the contact lenses despite her parents' active encouragement. CONCLUSION Tinted contact lenses offer an alternative management of the photophobia associated with stationary cone dystrophies in children. Marked improvements in their quality of life were observed in this case series.
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Affiliation(s)
- S N Rajak
- Sussex Eye Hospital, Brighton and Sussex University Hospital, Brighton, United Kingdom.
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18
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Walline JJ, Jones LA, Chitkara M, Coffey B, Jackson JM, Manny RE, Rah MJ, Prinstein MJ, Zadnik K. The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) Study Design and Baseline Data. Optom Vis Sci 2006; 83:37-45. [PMID: 16432471 DOI: 10.1097/01.opx.0000195566.94572.eb] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to describe the baseline characteristics of subjects and methods for a multicenter, randomized clinical trial to compare the effects of contact lens wear and spectacle wear on children's self-perception. METHODS Eligible subjects are randomly assigned to wear glasses or contact lenses throughout the 3-year study. Self-perceptions are measured 1 month after randomization and every 6 months using the Self-Perception Profile for Children (SPPC). Children's satisfaction with spectacles and refractive error-related visual quality of life are also measured using surveys developed for the study. Visual acuity, cycloplegic autorefraction, corneal curvature, and axial dimensions are measured annually. RESULTS Five clinical sites enrolled 484 subjects with a mean (+/- standard deviation [SD]) age of 10.4 +/- 1.1 years. Approximately three-fifths of the subjects are girls, 47.1% of the subjects are white, 21.5% are black, and 21.5% are Hispanic. The mean (+/- SD) cycloplegic spherical equivalent autorefraction of the right eye is -2.38 +/- 1.04 D, and the average (+/- SD) axial length of the right eye is 24.32 +/- 0.77 mm. The average (+/- SD) Global Self-Worth score on the SPPC is 3.20 +/- 0.62 on a scale from one (low perceived competence) to 4 (high perceived competence). The average (+/- SD) spectacle satisfaction is 59.1 +/- 26.6 on a scale from zero (no satisfaction) to 100 (perfect satisfaction). The average refractive error-related quality of life score is 63.5 +/- 12.8 on a scale from zero (poor quality of life) to 100 (excellent quality of life). CONCLUSIONS Subjects enrolling in the ACHIEVE Study are an ethnically diverse group of young myopic children. Ocular characteristics of the sample are consistent with data presented in other randomized clinical trials evaluating treatments for myopic children. The data reported here represent the baseline data for a 3-year randomized clinical trial to investigate the effects of contact lens vs. spectacle wear on children's self-perceptions.
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Affiliation(s)
- Jeffrey J Walline
- The Ohio State University College of Optometry, 338 West Tenth Avenue, Columbus, OH 43210-1240, USA.
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Trikalinos TA, Andreadis IA, Asproudis IC. Decision analysis with Markov processes supports early surgery for large-angle infantile esotropia. Am J Ophthalmol 2005; 140:886-893. [PMID: 16310465 DOI: 10.1016/j.ajo.2005.05.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2005] [Revised: 05/19/2005] [Accepted: 05/19/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess tradeoffs in time spent with aligned visual axes or stereopsis and risked reoperations between three strategies for the treatment of large-angle infantile esotropia: first surgery at 6, 24, or 48 months of age. DESIGN Decision analysis. METHODS We simulated three hypothetic cohorts of children with this condition until their eighth year. Potential achievement of stereopsis, the diagnosis of dissociated vertical divergence or inferior oblique overaction, and various complications were modeled. Probability estimates were obtained from a comprehensive literature review. Analyses aimed to determine the strategy that was associated with longer time spent with aligned eyes and/or stereopsis and fewer reoperations. RESULTS Eight-year-old children are expected to spend 72.6 vs 58.0 vs 37.8 months with aligned eyes and 26.8 vs 9.0 vs 1.5 months with stereopsis and to receive on average 1.76 vs 1.67 vs 1.46 surgeries, if they first underwent operation at 6 vs 24 vs 48 months, respectively. Children at 8 years are expected to have stereopsis at the rate of 36.1% vs 17.2% vs 5.1%, respectively. Operation at 6 months instead of 48 months is expected to yield an additional 9% of total follow-up time in health states with eye alignment and 11% in health states with stereopsis, per 5% increase in risk for extra operations (5% and 7%, respectively, per 5% increase in risk for operation at 6 vs 24 months). Wide-range sensitivity analyses and long-term projections point to the same direction. CONCLUSION Given the benefit/risk tradeoffs, it is probably warranted to attempt to correct large-angle infantile esotropia as early as possible.
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Affiliation(s)
- Thomas A Trikalinos
- Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, Massachusetts, USA.
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20
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Abstract
PURPOSE The aim of the study was to investigate the psychological profile of mothers of children with strabismus, their attitudes to their children, and their family functioning. METHODS This study was conducted at Dokuz Eylül University School of Medicine, from 2000 to 2002 and involved a series of 30 children with strabismus and 31 healthy controls. All mothers were asked to complete Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Parental Attitude Research Instrument (PARI), and Family Assessment Device (FAD). RESULTS Mothers of the children with strabismus had significantly higher depression scores ( P = 0.042) compared with mothers of the control group. They demonstrated significantly lower scores in democratic attitude, meaning that they failed to constitute a supportive and friendship relation with their children, ( P = 0.0001). These mothers had significantly higher scores in rejection of maternal role ( P = 0.017) as compared with mothers of the control group. They were nervous, distressed, and angry in the relationship with their children, with unhappiness and more dissatisfaction with respect to maternal role. Mothers of the children with strabismus had poor role functioning in the family, which is related to satisfying the food, clothing, and support needs ( P = 0.034). They also had poor affective responsiveness, which means the ability of family members to respond with appropriate emotion ( P = 0.003), and poor general functioning ( P = 0.040) as compared with mothers of the control group. CONCLUSIONS This study demonstrated that, for mothers who have children with strabismus, strabismus had an adverse effect on their lives, and their family relationships.
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Affiliation(s)
- Aynur Pekcanlar Akay
- Department of Child and Adolescent Psychiatry, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
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21
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Archer SM, Musch DC, Wren PA, Guire KE, Del Monte MA. Social and emotional impact of strabismus surgery on quality of life in children. J AAPOS 2005; 9:148-51. [PMID: 15838442 DOI: 10.1016/j.jaapos.2004.12.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Improved quality of life after strabismus surgery has been demonstrated in adults, but has not been extensively studied in children. The purpose of this study was to evaluate the psychosocial effects of childhood strabismus surgery. METHODS This was a prospective interventional study. A modified version of the RAND Health Insurance Study quality of life instrument was administered to parents or guardians of children with strabismus. The questionnaire was administered by telephone interviews conducted by trained staff before and 2 months after corrective surgery. RESULTS Ninety-eight children with a mean age of 4.5 (+/-3.3) years were studied. Reliability measures (Cronbach's alpha coefficients) indicate that the questionnaire has good internal consistency (alpha > 0.7 in most subscales). Compared with before surgery, significant improvements were noted after surgery, especially within the functional limitations (paired Student's t -test, P = 0.01), social relations ( P < 0.01), general health perceptions ( P < 0.01), and developmental satisfaction ( P < 0.01) subscales. CONCLUSIONS Parental proxies can provide meaningful measures of children's response to strabismus surgery. Statistically significant improvements were observed in social, emotional, and functional measures of the children's health status. As previously documented for adults, this study shows that psychosocial benefits afforded by strabismus surgery also contribute to an improvement in quality of life for children.
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Affiliation(s)
- Steven M Archer
- Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105. USA.
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Hemmerdinger C, Rowe N, Baker L, Lloyd IC. Bimedial hang-back recession— outcomes and surgical response. Eye (Lond) 2005; 19:1178-81. [PMID: 15688058 DOI: 10.1038/sj.eye.6701715] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIM To report outcomes and identify factors affecting surgical response for constant esotropia using 'hang-back' bimedial rectus recession. STUDY TYPE Retrospective case series analysis. METHODS Patients managed by a single surgeon over a 4-year study period were categorized into esotropia types: infantile, partially accommodative, nonaccommodative and secondary esotropia. Postoperative alignment was compared between types, and regression modelling used to examine factors predicting surgical response. RESULTS In all, 95% (18/19) of children with partially accommodative esotropia achieved postoperative deviation <15 prism dioptres from orthotropia, compared to 56% (15/27) of children with infantile esotropia, 69% (11/16) of children with non-accommodative esotropia and all (2/2) of those with secondary esotropia. Surgical response (Delta/mm recession performed) increased with the magnitude of both preoperative deviation (P<0.001) and anisometropia (P<0.001); the effect of deviation on surgical response was reduced by amblyopia (P=0.02). Age at surgery was statistically associated (P=0.002) but had negligible clinical effect on response. CONCLUSIONS Surgical response to hang-back recession may be partially predicted by preoperative factors.
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Affiliation(s)
- C Hemmerdinger
- Manchester Royal Eye Hospital, Oxford Road, Manchester, UK
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Abstract
PURPOSE Patients with socially significant strabismus may be at risk for certain psychosocial consequences. However, the magnitude at which strabismus becomes socially significant is ill defined. Suggested criteria for socially significant strabismus can be found in the literature, but they are rarely, if ever, referenced. The purpose of this study is to further define the magnitude at which strabismus becomes socially significant according to lay observers. METHODS Strabismus was simulated using photo manipulation and off-center fixation. Horizontal deviations were created in 3Delta steps up to 24Delta. One model was used for all photos. The photos were presented in random order to non-health care professionals (N = 58). Participants were instructed to view each picture and determine: "yes, this person has an eye turn" or "no, this person does not have an eye turn." A chi test was used for analysis. RESULTS.: There was an increase in the likelihood of strabismus detection as the size of the angle increased for exotropia and esotropia. Overall, exotropia was easier to identify than esotropia. For esotropia, a dramatic increase in detectability occurred between 9Delta (47.41% detection; p = 0.001) and 12Delta (67.24% detection; p = 0.001), with 70% detection being achieved at 14.5Delta. A significant increase in detection of exotropia occurred between 6Delta (60.34% detection; p = 0.001) and 9Delta (77.59% detection; p = 0.001), with 70% detection achieved at 8Delta. CONCLUSIONS Our results suggest that exotropia is easier for lay observers to detect than esotropia, with the critical magnitude (70% detection) being 14.5Delta for esotropia and 8Delta for exotropia. This refutes generally accepted beliefs that esotropia is easier to detect than exotropia. Additional studies are needed to look at the effect of ethnicity, sex, and age. Multiple models should be used to reduce the possible influence of distinct facial characteristics and increase the generalizability of the results.
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Affiliation(s)
- Erik Weissberg
- New England College of Optometry, 424 Beacon Street, Boston, MA 02115, USA.
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Abstract
Pediatric ophthalmologists should respond to quality expectations inherent in all disciplines of medicine. The specialists must be able to collect data to document and prove the quality of their work if it anticipates continued reimbursement for services. Quality of medical practice is assessed by outcomes research, which is different from clinical research. All specialists are systemically measuring individual and group outcomes across the spectrum of American health care systems. Pediatric ophthalmologists, both in private practice and at academic centers, must concentrate their research efforts on the assessment of cost, quality, utilization, and patient-centered health-related quality of life for the most common pathologies in pediatric ophthalmology practice.
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Affiliation(s)
- R W Enzenauer
- Department of Ophthalmology, University of Tennessee College of Medicine, Chattanooga 37403, USA.
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Abstract
PURPOSE The purpose of this study was to assess the psychosocial effects of growing up with and living with amblyopia and to determine whether patients with amblyopia but without strabismus encounter psychosocial problems similar to those encountered by individuals with strabismus. METHODS A 20-question survey focusing on medical background, education, self-image, history of amblyopia, treatment of amblyopia, and effects of amblyopia on work, school, friendships, and self-esteem was provided to patients with amblyopia but not strabismus at Saint Louis University Eye Institute and at the University of Iowa Department of Ophthalmology. In addition, patients were evaluated in terms of somatization, obsession-compulsion, interpersonal sensitivity, depression, and anxiety. Results for patients with amblyopia were compared with those of strabismic, normative, and psychopathologic groups using the Hopkins Symptom Checklist (HSC). RESULTS Twenty-five patients with amblyopia but without strabismus or previous surgery responded. A significant number of patients felt that amblyopia interfered with school (52%) and work (48%) to some degree and were generally affected in their lifestyle (50%). Fewer were affected in their play of sports (40%) or were influenced as to their job choice (36%). Patients with amblyopia as a whole had a greater degree of somatization, obsessive-compulsive behavior, interpersonal sensitivity, depression, and anxiety than patients with strabismus and HSC control subjects. Differences between patients with amblyopia and those with strabismus were not statistically significant (P > .05), but differences between patients with amblyopia and HSC control subjects were significant (P < .05) in each category. Patients with amblyopia, however, were less symptomatic in these areas than HSC Anxious and HSC Depressed groups. CONCLUSION Psychosocial difficulties related to amblyopia affect individuals' self-image, work, school, and friendships. Amblyopia has a significant effect on psychosocial functioning and warrants aggressive screening, prevention and treatment during the amblyogenic years.
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Affiliation(s)
- E A Packwood
- Saint Louis University Eye Institute, Saint Louis University School of Medicine, Missouri, USA
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