Visual and auditory attention defects in children with intermittent exotropia

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.

Strabismus and Health Related Quality of Life in a pediatric Portuguese population

Introduction: Strabismus is a common condition among children, and its psychosocial impact has been demonstrated in recent years. The interest in a more comprehensive approach was enhanced by the recognition of health as a four-dimensional concept, arising the term Health-related Quality of Life. Therefore, we aim to evaluate the influence of strabismus in Health-Related Quality of Life of a Portuguese pediatric population. Material and Methods: Case-control prospective transversal study enrolling children between 5 and 12 years old. All had a complete orthoptic and ophthalmological evaluation, followed by an interview with a legal representative to answer the Pediatric Quality-of-Life Inventory 4.0, proxy-version. Results: Seventy-one children were included, 35 in the control group (CG) and 36 in the strabismus group (SG). In the SG, 30 (83.3%) patients had esotropia, 20 (55.6%) had more than 10 prismatic diopters and 26 (72.2%) were already surgically treated. Overall, SG was not statistically different from the CG, showing only mild inferior performance (p > .05). Furthermore, children with exotropia, higher deviations, none or gross stereoacuity and treatment-naïve, scored worse, especially in emotional, social, educational and psychosocial scores although not statistically significant (p > .05). Conclusion: This is the first prospective study addressing HRQoL and strabismus in a pediatric Portuguese population. It would be relevant to further address this issue in order to delineate more effective and global treatment strategies, not only considering ophthalmological goals but also the well-being of both children and guardians.

Infantile esotropia in Malaysian children: The impact of surgery on health-related quality of life assessment in patients and their parents

INTRODUCTION

Limited information is available on healthrelated quality of life (HRQoL) in children with strabismus in South East Asia. We aimed to evaluate the HRQoL and associated factors pre- and post-strabismus surgery in Malaysian children with infantile esotropia and their parents/guardians.

METHODS

A prospective study was conducted on children with infantile esotropia aged 8-17 years old and their parents/guardians who attended two tertiary hospitals with a paediatric ophthalmology service from 2017 to 2018. The patients and parents answered the Intermittent Exotropia Questionnaire (IXTQ), translated into Malay, at the time of enrolment and three months after the surgery.

RESULTS

Thirty-four children and one (each) of their parents/guardians were enrolled. Thirteen (38.2%) children had esotropia with angles of deviation of more than 50 prism dioptres. A total of 33 (97.1%) children achieved successful alignment correction three months after surgery. Surgery significantly improved the total mean scores of the children, which were 62.87 (17.05) preoperatively and 87.13 (13.26) postoperatively (p<0.001). There was statistically improvement in the total mean scores in the parent/guardian group, which was 37.07 (22.01) preoperatively and 75.39 (22.09) postoperatively (p<0.001). The parents/guardians functional, psychosocial and surgery subscales also had a significant increment in the score postoperatively (p<0.001). Older children and children with poorer visual acuity on presentation had a lower score preoperatively, while girls scored better postoperatively (p<0.05). Mothers scored significantly lower preoperatively and postoperatively (p<0.05).

CONCLUSION

Surgery significantly improved the HRQoL score in Malaysian children with infantile esotropia and their parents/guardians. The score was significantly higher in female children after the surgery. Mothers exhibited poor scores before and after surgery.

Effectiveness of strabismus surgery on the health-related quality of life assessment of children with intermittent exotropia and their parents: a randomized clinical trial

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.

Associations between health-related quality of life and the decision to perform surgery for childhood intermittent exotropia

OBJECTIVE

To assess associations between health-related quality of life (HRQOL) and the decision to perform strabismus surgery for children with intermittent exotropia.

DESIGN

Retrospective chart review.

PARTICIPANTS

Children with intermittent exotropia.

METHODS

Included subjects, identified in a clinical practice, had assessment of HRQOL using the intermittent exotropia questionnaire (IXTQ), comprising child, proxy, and parent components (parent domains: function, psychosocial, and surgery). The IXTQ scores were evaluated for association with surgery, along with standard clinical measures: prism and alternate cover test (PACT), stereoacuity, and control score (mean of the 3 most recent scores). Included data were from preoperative examination (surgical cohort) or from most recent follow-up examination (nonsurgical cohort). Univariate and multivariate logistic regression analyses were performed, and relative risk (RR) ratios were calculated. Spearman rank correlations were calculated to identify highly correlated items.

MAIN OUTCOME MEASURES

Association of individual factors with the decision to perform surgery, calculated using RR ratios.

RESULTS

One hundred six children with intermittent exotropia (median age, 6 years; range, 2-16 years) were eligible for inclusion. Nineteen (18%) of 106 underwent surgery. Using all available data, the IXTQ proxy score, IXTQ parent function score, IXTQ parent psychosocial score, distance control score, near control score, near PACT, and Randot Preschool stereoacuity (Stereoptical Co, Inc, Chicago, IL) were associated with undergoing surgery (P<0.1). Sixty-nine of 106 patients had complete data on all factors identified in univariate analysis and were included in multivariate analyses. Fourteen (20%) of these 69 patients underwent surgery. In multivariate analyses, poor distance control score (RR, 1.83; 95% confidence interval [CI], 1.25-2.68) and reduced IXTQ parent function score (RR, 0.96; 95% CI, 0.92-0.99) were associated with surgical intervention. Repeat multivariate analyses retaining only 1 of the highly correlated items showed IXTQ proxy, IXTQ parent psychosocial, larger near PACT, and worse near control were also associated with surgery.

CONCLUSIONS

After accounting for poorer exodeviation control at distance, reduced parent and proxy HRQOL were associated with undergoing strabismus surgery for childhood intermittent exotropia. Recognizing reduced parental HRQOL may be important, with a possible role for educational or counselling interventions.

Distance stereoacuity in intermittent exotropia

BACKGROUND

Studies of distance stereoacuity in intermittent exotropia suggest that normal stereoacuity corresponds to good control of the deviation and that reduced or negative stereoacuity signifies poorer control.

AIM

: To evaluate distance stereoacuity in intermittent exotropia using the Frisby Davis Distance stereo test (FD2).

METHODS

Children with intermittent exotropia where the near angle was less than or equal to distance were eligible for recruitment. Standardised prospective data collection included FD2 distance stereoacuity. This was a longitudinal study in which outcomes are reported for baseline, last follow-up (> or =6 months before any surgery) or preoperative and last postoperative visits for those undergoing surgery.

RESULTS

110 children with intermittent exotropia had FD2 stereoacuity tested at baseline: 70 comprehended the test. Mean (standard deviation (SD)) age was 4.6 (1.7) years (range 2-10 years). 41/70 (59%) showed positive responses: mean (SD) stereoacuity 30 (12) s of arc. The mean follow-up period before any surgery was 13 months (range 6-27 months). At follow-up, mean (SD) stereoacuity was 24 (11) s of arc. Preoperative and postoperative stereoacuity were not significantly different from those not undergoing surgery.

CONCLUSION

This study was the first to report distance stereoacuity in intermittent exotropia using the FD2 stereo test: patients with intermittent exotropia can achieve normal levels of distance stereoacuity, but a considerable proportion, despite comprehending, showed a negative response. This suggests that using the FD2, distance stereoacuity in intermittent exotropia is either absent or normal rather than reduced. Possible reasons for this and its implications are discussed.

Impact of large angle horizontal strabismus on ability to obtain employment

OBJECTIVE

To determine if large angle esotropia and exotropia could impact a person's ability to obtain employment.

DESIGN

Laboratory experiment.

PARTICIPANTS

Seventy-nine respondents unaware of the purpose of the study.

METHODS

Photographs of two men and two women were digitally altered to create photographs of the same individual in an orthotropic, esotropic, and exotropic state. The photographs were then randomly affixed to similarly qualified job resumes. The 79 study respondents, unaware of the purpose of the study, were asked to (1) rate each individual applicant on selected job qualification variables, and (2) rank the applicants against each other in order of hiring preference.

MAIN OUTCOME MEASURES

Individual applicant rating and hiring preference scores.

RESULTS

Women with normal ocular alignment received greater hiring preference scores than did strabismic women (P = 0.007). No difference in hiring preference scores was noted between strabismic and non-strabismic male applicants (P = 0.47).

CONCLUSIONS

Large angle horizontal strabismus appeared to be vocationally significant for female applicants, reducing a strabismic female applicant's ability to obtain employment. The presence of strabismus did not appear to influence hiring decisions of male applicants.

Prospective comparison of convergence insufficiency and normal binocular children on CIRS symptom surveys. Convergence Insufficiency and Reading Study (CIRS) group

PURPOSE

To test the validity-related evidence of a child and a parent symptom survey developed by the Convergence Insufficiency and Reading Study (CIRS) group.

METHODS

A case comparison method was used to measure differences in symptoms between 14 school-aged children (ages 8 to 13 years) with Convergence Insufficiency (CI) and 14 children with normal binocular vision (NBV).

RESULTS

A pooled t-test indicated that CI children and their parents scored higher than the NBV children and their parents on the child's survey (p<0.001) and parent's survey (p<0.001), respectively. CI children also scored significantly higher (p<0.03) on the Conners' Rating Scale for Parents.

CONCLUSIONS

The results suggest that the CIRS symptom survey is a valid instrument for differentiating CI children from those with normal binocular vision. Additionally, children in this age group were able to respond to a broad range of symptom questions associated with CI.

Psychosocial implications of strabismus surgery in adults

PURPOSE

Adults with socially noticeable strabismus have been known to experience psychosocial difficulties as a result of their abnormal eye position. This study was designed to assess the impact of noticeable strabismus in adults and the psychosocial effects of surgical correction.

METHODS

A total of 31 adults who underwent surgery for longstanding horizontal strabismus where poor alignment was the primary reason for consenting to surgery were requested to complete a self-reporting repertory grid to appraise the psychosocial consequences of corrective strabismus surgery.

RESULTS

Prior to corrective surgery, the majority of subjects reported various psychosocial difficulties, considered by them to be wholly or partly due to their unsightly strabismus. A significant improvement in interpersonal interactions is apparent following strabismus surgery.

CONCLUSION

Surgery to improve ocular alignment appears to herald major improvements in the quality of psychosocial functioning for the majority of adults undergoing such surgical procedures (P < 0.001).

A case-comparison of intermittent exotropia and quality of life measurements

A Vision Quality of Life Questionnaire that combines the SF-20 and a Vision Quality Scale developed by the authors was pilot tested in a case-comparison of extreme groups, patients with intermittent exotropia (IXT) and those with no vision problems (Non-IXT), at the University of Houston (UH) Optometry Clinic. The purposes of the study were to measure the internal consistency reliability and examine the validity-related evidence of vision function associated with the instrument. The pilot study involved mailing the instrument to 52 patients in each group (IXT and Non-IXT patients). IXT patients were then frequency-matched by age and separately by sex, to control for confounding variables, to Non-IXT group patients. The Cronbach's Alpha internal consistency reliability of both scales was acceptable at > 0.70 for both the IXT and Non-IXT groups. The Wilcoxon signed ranks test was used to determine validity-related evidence. The differences between groups on the SF-20 (p = 0.0276) and Vision Function Scale (VFS) (p = 0.0385) confirm that the scales discriminate between IXT and Non-IXT populations. Two conclusions can be drawn from the pretesting and pilot testing of the SF-20 and the VFS: (1) both have acceptable internal consistency reliability scores, and (2) both show validity-related evidence that they can discriminate vision function between IXT and Non-IXT patient populations.

Binocularity and photophobia in intermittent exotropia

The relationship between photophobia and binocular function in intermittent exotropia was examined in 42 subjects (21 patients and 21 controls). In all subjects fusional amplitude and strength of binocular sensory status were tested before and during exposure to bright light. An explanation of photophobia in intermittent exotropia was suggested as impairment in binocular cooperation, since the indicators of binocular function were significantly altered in the patients, particularly during light exposure.