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Original Investigation
June 10, 2021

Association of Allergic Conjunctivitis With Health-Related Quality of Life in Children and Their Parents

Author Affiliations
  • 1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
JAMA Ophthalmol. Published online June 10, 2021. doi:10.1001/jamaophthalmol.2021.1708
Key Points

Question  Is allergic conjunctivitis associated with health-related quality of life in children and their parents?

Findings  This case-control study including 188 children and their parents noted that allergic conjunctivitis had an association with reduced health-related quality of life for both children and their parents. This reduction was most prominent in children with vernal keratoconjunctivitis and atopic keratoconjunctivitis.

Meaning  The findings of this study suggest a multifaceted association of allergic conjunctivitis with quality of life; detailed assessment of quality of life for improved care of pediatric patients with chronic allergic conjunctivitis would be useful.


Importance  Allergic conjunctivitis (AC) is one of the most common allergic diseases and is especially problematic in children and adolescents. The course of AC is generally prolonged and often recurs. Understanding the health-related quality of life (QOL) of both children with AC and their parents would be useful.

Objective  To evaluate the association between AC and health-related QOL in children and their parents.

Design, Setting, and Participants  A prospective case-control study was conducted at Zhongshan Ophthalmic Center, a single tertiary referral center, from November 16, 2019, through January 20, 2020. Participants comprised 92 children aged 5 to 18 years with AC and their parents and 96 healthy, age-matched children who served as controls and their parents. The 92 children in the AC group were subdivided into cohorts with vernal keratoconjunctivitis (VKC) (23 [25.0%]) or atopic keratoconjunctivitis (AKC) (7 [7.6%]) and seasonal allergic conjunctivitis (SAC) (26 [28.3%]) or perennial allergic conjunctivitis (PAC) (36 [39.1%]).

Exposures  Allergic conjunctivitis.

Main Outcomes and Measures  Pediatric Quality of Life Inventory, version 4.0 (PedsQL), scores for children and their parents. Scores range from 0 to 100, with higher scores indicating better health-related QOL and fewer negative aspects.

Results  In the AC group, 77 of 92 (83.7%) participants were boys, and 67 (72.8%) of the parents were women. Of the individuals in the control group, 55 of 96 (57.3%) of the children were girls and 76 (79.2%) of the parents were women. Median total PedsQL scores were reduced in both children with AC (69.6 [interquartile range [IQR], 66.3-72.8 vs 96.7; IQR, 92.7-98.9; P < .001) and their parents (68.8; IQR, 63.9-71.4 vs 96.5; IQR, 95.1-97.9; P < .001). The reduction in health-related QOL was more severe in children with VKC/AKC than in those with SAC/PAC (difference, –3.3; 95% CI, –5.4 to –1.1; P = .004) and their parents (difference, –4.3; 95% CI, –7.1 to –2.1; P < .001). In the AC group, a higher corneal fluorescein staining score was associated with lower QOL in children (β, –1.16; 95% CI, –1.80 to –0.52; P = .001); higher corneal fluorescein staining scores (β, –1.12; 95% CI, –1.74 to –0.50; P = .001) and multiple clinical consultations (β, –3.96; 95% CI, –7.34 to –0.57; P = .02) were associated with lower QOL in parents. The parents' QOL scores were correlated with their children's QOL scores (correlation coefficient, r = 0.59; P < .001).

Conclusions and Relevance  These findings suggest AC has a negative association with health-related QOL for children and their parents, especially in children with VKC/AKC or higher corneal fluorescein staining scores.

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