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Jonathan M Holmes, David A Leske, Sarah R Hatt; Factors associated with failure to improve health-related quality-of-life following adult strabismus surgery. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2921. doi: https://doi.org/.
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A number of clinical and psychosocial factors have been identified as being associated with poor health-related quality of life (HRQOL) in adult strabismus. Average HRQOL scores improve across patients undergoing strabismus surgery, but there are few data on factors associated with failure of HRQOL to improve.
276 adults (median age 57 years, range 18 to 91) undergoing strabismus surgery completed the Adult Strabismus 20 (AS-20), Diplopia Questionnaire (DQ), CESDR (depressive symptoms), and DS-14 (type-D personality) questionnaires both pre-op and 6-weeks post-op (median 57 days, range 27 to 150 days). Pre-op to post-op changes in AS-20 scores (0-100) were calculated for each of the 4 AS-20 domains. Univariate logistic regression, followed by stepwise multiple logistic regression analysis, was performed to assess factors associated with failure to improve (<1 point) for each of the 4 domains, including only patients with room to improve for analysis of that domain. Factors assessed were: age (onset and at surgery), sex, DQ scores (pre and post), alignment (SPCT) as a vector (pre and post), esotropia (pre and post), vertical deviation (pre and post), visual acuity, CESDR scores (pre and post), type-D personality (pre and post), number of previous surgeries, and presence of facial abnormality. Separate models were created when factors were highly correlated.
Failure to improve in each of the 4 domains was associated with higher post-op diplopia scores. In addition, failure to improve in Self-Perception was associated with post-op type-D personality. Failure to improve in Interactions was associated with post-op depressive symptoms (higher CESDR scores). In Reading Function, failure to improve was associated with better pre-op visual acuity and failure to improve in General Function was associated with younger age of onset.
Pre-op factors had little influence on failure to improve in each of the 4 AS-20 HRQOL domains following adult strabismus surgery, whereas several post-op factors were found to be strongly associated, including post-op diplopia, post-op depressive symptoms, and post-op type-D personality. These post-op factors may be important in assessing surgical outcomes and in management of adults with strabismus.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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