April 2009
Volume 50, Issue 13
ARVO Annual Meeting Abstract  |   April 2009
Improvement in Health Related Quality of Life in Adults Following Strabismus Surgery
Author Affiliations & Notes
  • J. M. Holmes
    Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
  • S. R. Hatt
    Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
  • D. A. Leske
    Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
  • Footnotes
    Commercial Relationships  J.M. Holmes, None; S.R. Hatt, None; D.A. Leske, None.
  • Footnotes
    Support  NIH Grant EY015799 (JMH), Research to Prevent Blindness, Inc., and Mayo Foundation
Investigative Ophthalmology & Visual Science April 2009, Vol.50, 1204. doi:
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    • Get Citation

      J. M. Holmes, S. R. Hatt, D. A. Leske; Improvement in Health Related Quality of Life in Adults Following Strabismus Surgery. Invest. Ophthalmol. Vis. Sci. 2009;50(13):1204.

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

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Purpose: : To compare the responsiveness of 2 health related quality of life (HRQOL) instruments, the new strabismus-specific AS-20 and the NEI VFQ-25, in adults undergoing strabismus surgery.

Methods: : 37 adults with strabismus (aged 21 to 82 years, median 51) who were successfully aligned postoperatively, completed the AS-20 and VFQ-25 preoperatively and a median of 8 weeks postoperatively (range 4 to 13 weeks). 25 patients had diplopia, and 12 had no diplopia. Each questionnaire (overall and subscales) was scaled from 0 (worst HRQOL) to 100 (best HRQOL). 95% limits of agreement (LOA) for both AS-20 and VFQ-25 were defined in a previous test-retest study and real change in HRQOL was defined as change exceeding the 95% LOA. We compared proportions of patients showing real change.

Results: : Overall, more patients showed an improvement in AS-20 score compared to composite VFQ-25 score (21 [58%] of 37 vs 11 [30%]; P=0.01). Analyzing by whether the patient had diplopia or not, more patients without diplopia showed improvement in AS-20 than VFQ-25 (7 [58%] of 12 vs 0 of 12). On AS-20 subscales, 8 (67%) of 12 improved on the psychosocial subscale and 1 (8%) improved on the function subscale. On the 5 potentially useful VFQ-25 subscales (identified in a previous study), only 2 (17%) of 12 non-diplopic patients improved on Vision-specific (VS) role difficulties and VS social functioning subscales, and only 1 (8%) improved on VS dependancy; no patients showed improvement on the VS mental health and Peripheral vision subscales. In contrast, for diplopic patients, the AS-20 and VFQ-25 were more comparable. Similar proportions showed improvement in composite AS-20 and VFQ-25 scores (14 [56%] of 25 vs 11 [44%]; P=0.3). On AS-20 subscales, 10 (40%) of diplopic patients improved on the function subscale and 6 (24%) improved on the psychosocial subscale. On the 5 potentially useful VFQ-25 subscales, the proportion of diplopic patients showing improvement ranged from 54% to 12%: VS role difficulties: 13 (54%) of 25, VS mental health: 12 (48%), VS dependancy: 8 (32%); VS social functioning: 5 (20%), and Peripheral vision 3 (12%).

Conclusions: : For non-diplopic patients, the AS-20 is more responsive than the VFQ-25 to improvement in HRQOL following strabismus surgery. For diplopic patients both questionnaires are responsive. The new strabismus-specific AS-20 questionnaire is useful over the entire spectrum of strabismus and addresses both function and psychosocial issues.

Keywords: strabismus • esotropia and exotropia • quality of life 

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