June 2013
Volume 54, Issue 15
ARVO Annual Meeting Abstract  |   June 2013
Factors Associated with Poor Health-Related Quality of Life in Adult Strabismus
Author Affiliations & Notes
  • Sarah Hatt
    Ophthalmology, Mayo Clinic, Rochester, MN
  • David Leske
    Ophthalmology, Mayo Clinic, Rochester, MN
  • Laura Liebermann
    Ophthalmology, Mayo Clinic, Rochester, MN
  • Jonathan Holmes
    Ophthalmology, Mayo Clinic, Rochester, MN
  • Footnotes
    Commercial Relationships Sarah Hatt, None; David Leske, None; Laura Liebermann, None; Jonathan Holmes, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 5987. doi:
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      Sarah Hatt, David Leske, Laura Liebermann, Jonathan Holmes; Factors Associated with Poor Health-Related Quality of Life in Adult Strabismus. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5987.

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      © ARVO (1962-2015); The Authors (2016-present)

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Health-related quality of life (HRQOL) is often reduced in adults with strabismus, but it is unclear which factors are specifically associated with poor HRQOL. Non-strabismus studies have reported associations between depression and/or type-D (distressed) personality and poor HRQOL. We investigated associations between clinical, demographic or psychological factors, and HRQOL in adults with strabismus.


68 adult strabismus patients completed the Adult Strabismus-20 (AS-20) strabismus- specific questionnaire at their clinic visit, providing HRQOL scores (0 to 100, worst to best HRQOL) on each of the four AS-20 subscales: Self-perception, Interaction, Reading Function and General Function. Included patients also completed depression and personality questionnaires. Factors considered for association with poor HRQOL were: diplopia severity using a diplopia questionnaire (DQ) (scored 0 to 100), depression score (0 to 60) using the CESDR questionnaire, Type D personality (Yes/No) using the DS-14 questionnaire, age, sex, worst eye visual acuity, co-morbidity, direction of deviation, and magnitude of deviation (worst of distance or near vector). Multiple linear regression models were run for each of the four AS-20 subscales. Factors were considered associated with poor HRQOL if p<0.05.


Lower Self-perception AS-20 scores (indicating poorer HRQOL) were associated with younger age (p<0.0001), greater magnitude of deviation (p=0.002) and higher (worse) CESDR score (p=0.005). Lower Interaction AS-20 scores were associated with higher CESDR score (p=0.007) and younger age (p=0.007). For both Reading and General Function subscales, lower scores were associated with higher (worse) DQ scores (p<0.0001 for both) and higher CESDR scores (p=0.03 and p=0.0003).


Poorer HRQOL was associated with higher depression scores (indicating subclinical depression) across all four AS-20 subscales. In addition, depending on the specific AS-20 subscale, greater magnitude of deviation, younger age and higher diplopia score were also associated with poor HRQOL. The association of subclinical depression with poor HRQOL may be particularly important when interpreting patient reported outcomes, and warrants clinical consideration.

Keywords: 722 strabismus • 669 quality of life  

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