Abstract
Introduction
Quantification of the psychosocial effects of manifest strabismus has been made possible by the introduction of the Adult Strabismus 20 (AS-20) questionnaire. We investigated the effects of strabismus surgery and patient demographics on the pre- and postoperative AS-20 scores.
Methods
A prospective, cohort study of adult patients undergoing strabismus surgery. Full pre- and postoperative orthoptic measurements were analysed and compared with the AS-20 total scores and its subscales (psychosocial and functional). Any relationship between: gender; direction; and size of preoperative deviation and the changes in AS-20 score was investigated.
Results
Eighty-six patients were included with a follow-up of 91 days following surgery. Median deviation preoperatively was 30.5 prism diopters (PD) and the median preoperative AS-20 score was 45. Postoperatively, the median deviation was 8 PD and the AS-20 score was significantly (Z=−7.83, P<0.0001) higher at 73.1. Females have a lower preoperative AS-20 score (P=0.01) but show a greater improvement in scores following surgery compared with males (P=0.058). There is a close correlation between change in AS-20 score and change in deviation size (r=0.291, P=0.006).
Conclusion
Strabismus surgery gives a highly significant improvement in quality-of-life scores. Females gain more benefit from surgery and there is a greater improvement in the score with larger changes in deviation size. The smaller the postoperative angle, the larger the final AS-20 score.
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References
Coats DK, Stager DR Sr, Beauchamp GR, Stager DR Jr, Mazow ML, Paysse EA et al. Reasons for delay of surgical intervention in adult strabismus. Arch Ophthalmol 2005; 123: 497–499.
Satterfield D, Keltner JL, Morrison TL . Psychosocial aspects of strabismus study. Arch Ophthalmol 1993; 111: 1100–1105.
Burke JP, Leach CM, Davis H . Psychosocial implications of strabismus surgery in adults. J Pediatr Ophthalmol Strabismus 1997; 34: 159–164.
Hatt SR, Leske DA, Kirgis PA, Bradley EA, Holmes JM . The effects of strabismus on quality of life in adults. Am J Ophthalmol 2007; 144: 643–647.
Nelson BA, Gunton KB, Lasker JN, Nelson LB, Drohan LA . The psychosocial aspects of strabismus in teenagers and adults and the impact of surgical correction. J AAPOS 2008; 12: 72–76.
Jackson S, Harrad RA, Morris M, Rumsey N . The psychosocial benefits of corrective surgery for adults with strabismus. Br J Ophthalmol 2006; 90: 883–888.
Durnian JM, Owen M, Marsh IB . The psychosocial aspects of strabismus; correlation between the AS-20 and DAS59 quality-of-life questionnaires. J AAPOS 2009; 13: 477–480.
McKenzie JA, Capo JA, Nusz KJ, Diehl NN, Mohney BG . Prevalence and sex differences of psychiatric disorders in young adults who had intermittent exotropia as children. Arch Ophthalmol 2009; 127: 743–747.
Durnian JM, Noonan CP, Marsh IB . The psychosocial impact of adult strabismus: a review. Br J Ophthalmol 2011; 95: 450–453.
Hatt SR, Leske DA, Bradley EA, Cole SR, Holmes JM . Development of a quality-of-life questionnaire for adults with strabismus. Ophthalmology 2009; 116: 139–144.
Hatt SR, Leske DA, Bradley EA, Cole SR, Holmes JM . Comparison of quality-of-life instruments in adults with strabismus. Am J Ophthalmol 2009; 148: 558–562.
Leske DA, Hatt SR, Holmes JM . Test-retest reliability of health-related quality-of-life questionnaires in adults with strabismus. Am J Ophthalmol 2010; 149: 672–676.
Hatt SR, Leske DA, Holmes JM . Responsiveness of health-related quality-of-life questionnaires in adults undergoing Strabismus surgery. Ophthalmology 2010; 117 (12): 2322–2328.
Hatt SR, Leske DA, Liebermann L, Holmes JM . Changes in health-related quality of life 1 year following strabismus surgery. Am J Ophthalmol 2012; 153 (4): 614–619.
Menon V, Saha J, Tandon R, Mehta M, Khokhar S . Study of the psychosocial aspects of strabismus. J Pediatr Ophthalmol Strabismus 2002; 39: 203–208.
Durnian JM, Owen ME, Baddon AC, Noonan CP, Marsh IB . The psychosocial effects of strabismus: effect of patient demographics on the AS-20 score. J AAPOS 2010; 14 (6): 469–471.
Uretmen O, Egrilmez S, Kose S, Pamukçu K, Akkin C, Palamar M et al. Negative social bias against children with strabismus. Acta Ophthalmol Scand 2003; 81: 138–142.
Olitsky SE, Sudesh S, Graziano A, Hamblen J, Brooks SE, Shaha SH et al. The negative psychosocial impact of strabismus in adults. J AAPOS 1999; 3: 209–211.
Coats D, Paysse E, Towler A, Dipboye R . Impact of large angle horizontal strabismus on ability to obtain employment. Ophthalmology 2000; 107: 402–405.
Goff M, Suhr A, Ward J, Croley JK, O'Hara MA . Effect of adult strabismus on ratings of official US army photographs. J AAPOS 2006; 10: 400–403.
Leske DA, Hatt SR, Liebermann L, Holmes JM . Evaluation of the Adult Strabismus-20 (AS-20) questionnaire using Rasch analysis. Invest Ophthalmol Vis Sci 2012; 53: 2630–2639.
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Glasman, P., Cheeseman, R., Wong, V. et al. Improvement in patients' quality-of-life following strabismus surgery: evaluation of postoperative outcomes using the Adult Strabismus 20 (AS-20) score. Eye 27, 1249–1253 (2013). https://doi.org/10.1038/eye.2013.174
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DOI: https://doi.org/10.1038/eye.2013.174
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