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Jonathan M Holmes, David A Leske, Danielle L Chandler, Pediatric Eye Disease Investigator Group; Effect of Patching Versus Observation on Intermittent Exotropia-Specific Health-Related Quality of Life in Children and their Parents. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4545.
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In a randomized trial we found part-time patching reduced the 6-month risk of intermittent exotropia (IXT) deterioration, compared with observation, from 6.0% to 0.6%. We now report the effect on IXT-specific health-related quality of life (HRQOL) in the children and their parents.
358 children aged 3 to <11 years with previously untreated IXT and near stereoacuity of at least 400 arcsec were randomly assigned to either observation or patching for 3 hours per day for 5 months, with outcome assessment at 6 months. HRQOL was assessed at baseline and 6 months using the IXT questionnaire (IXTQ). The IXTQ has 3 parts (Child, Proxy, Parent) with 5 domains: Child (for children ≥5yrs), Proxy (parent perceived effect on child), and Parental Function, Psychosocial and Surgery (measuring his/her own HRQOL). Scores range from 0 (worst HRQOL) to 100 (best).
Comparing changes in scores from baseline to 6 months between children prescribed observation versus patching, there were no differences in the magnitude of changes in IXT-specific HRQOL between treatment groups. Mean Child scores (n = 208) improved from 81.2 at baseline to 84.6 (P=0.009) at 6 months for those observed and 79.9 to 81.5 (P=0.4) in those patched (mean difference in improvement 3.3 vs. 1.6 points, P=0.3). Mean Proxy scores (n=326) were unchanged; 84.9 to 86.1 (p=0.4) in those observed and 86.7 to 86.0 (P=0.8) in those patched (mean difference 1.2 vs. -0.7, P=0.5). Mean Parental Function scores (n=327) improved from 57.0 to 65.3 (P<0.0001) in those observed and 59.1 to 68.0 (P<0.0001) in those patched (mean difference in improvement 8.3 vs. 8.9, P=0.4). Mean Parental Psychosocial scores improved from 65.7 to 73.8 (P<0.0001) in those observed and 70.5 to 76.2 (P<0.0001) in those patched (mean difference in improvement 8.1 vs. 5.8, P=0.9). Mean Parental Surgery scores improved from 52.6 to 57.9 (P=0.006) in those observed and 56.9 to 61.3 (P=0.0009) in those patched (mean difference in improvement 5.3 vs. 4.4, P=0.7).
Improvements in IXT-specific HRQOL were similar for children with IXT and their parents regardless of whether the children were observed or patched. Improvement in parental HRQOL may be due to reassurance by the care provider.
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