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David A Leske, Sarah R Hatt, Laura Liebermann, Jonathan M Holmes; Association of Specific Symptoms with Reduced Health-Related Quality of Life in Children with Intermittent Exotropia. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5207.
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To evaluate the relationship of specific intermittent exotropia (IXT) symptoms with health-related quality of life (HRQOL) in children with IXT and their parents.
The Intermittent Exotropia Questionnaire (IXTQ) was administered to a cohort of 35 children (aged 5-13 years) with IXT, without previous surgery, and their parents (Child, Proxy, Parent Psychosocial, Parent Function, and Parent Surgery subscales). All IXTQ questionnaires were Rasch scored using an established look-up table and converted to a 0-100 scale. Children also completed a 22-item symptom survey, rating symptoms as “not at all,” “sometimes,” or “a lot” for 5- to 7-year olds, or “never,” ‘almost never,” “sometimes,” “often,” or “almost always” for 8- to 17-year olds, yielding a score of 0 to 4 per item. Relationships between IXTQ scores and symptom scores were analyzed by univariate linear regression, and symptoms associated with poor HRQOL (P≤ 0.1) were fit to a stepwise multivariate linear regression model.
Lower (worse) Child IXTQ HRQOL scores were associated with symptoms of difficulty focusing eyes (P=0.0007), double vision (P=0.007), eyes hurting (P=0.006), and problems with eyes in the sun (P=0.06)(model r-square=0.64). Lower Proxy IXTQ scores were associated with child symptoms of eyes feeling funny (P=0.02) and eyes going in and out (P=0.06)(model r-square=0.27). Parent Psychosocial IXTQ scores were associated with eyes going in and out (P=0.02) and difficulty staring at things (P=0.03)(model r-square=0.23). Parent Function IXTQ scores were only associated with symptoms of eyes going in and out (P=0.04)(model r-square 0.12). No relationships were found between child symptoms and Parent Surgery IXTQ scores.
In Children with IXT, reduced child HRQOL is predicted by the specific symptoms of difficulty focusing eyes, double vision, eye pain, and problems with eyes in the sun. In contrast to child HRQOL, poor proxy or parental HRQOL are less explained by child symptoms, but are associated with the child experiencing symptoms of the eyes going in and out, eyes feeling funny, and difficulty staring at things. For clinical and research applications, a revised shortened symptom survey could be based on the questions we found to be associated with reduced HRQOL.
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