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Original Investigation
March 26, 2020

Association of Strabismus With Functional Vision and Eye-Related Quality of Life in Children

Author Affiliations
  • 1Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
  • 2Retina Foundation of the Southwest, Dallas, Texas
  • 3Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas
JAMA Ophthalmol. 2020;138(5):528-535. doi:10.1001/jamaophthalmol.2020.0539
Key Points

Question  How is childhood strabismus associated with the functional vision and quality of life of affected children and their parents as assessed using the newly developed Pediatric Eye Questionnaire?

Findings  In this cross-sectional study, we found that children with strabismus had lower functional vision and eye-related quality of life compared with visually normal healthy controls across multiple domains. Parents of children with strabismus also experienced a reduced quality of life compared with parents of visually normal controls.

Meaning  The association of strabismus with functional vision and eye-related quality of life in children should be considered when defining management goals.

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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