Original articleAssociations between Health-Related Quality of Life and the Decision to Perform Surgery for Childhood Intermittent Exotropia
Section snippets
Methods
Institutional review board approval was obtained from the Institutional Review Board at Mayo Clinic, Rochester, Minnesota, and all procedures and data collection were conducted in a manner compliant with the Health Insurance Portability and Accountability Act. All research procedures adhered to the tenets of the Declaration of Helsinki.
Results
One hundred six children (median age, 6 years; range, 2–16 years) were included; 19 (18%) of 106 underwent surgery. Most patients had basic, pseudodivergence excess, or true divergence excess types of intermittent exotropia. Only 3 patients had convergence insufficiency-type intermittent exotropia. As required for eligibility, all 106 patients had completed at least one component of the IXTQ. The parent component was completed in all 106 patients, the proxy component was completed in 105 of 106
Discussion
In assessing factors that influence the decision to perform surgery in children with intermittent exotropia, poorer parental and proxy HRQOL were strongly associated with surgery, after accounting for poor control of the exodeviation at distance. Children with intermittent exotropia whose accompanying parent reported poorer HRQOL were more likely to undergo surgery than those whose parents reported better HRQOL.
The parent component of the IXTQ measures parental HRQOL specifically as it relates
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Strabismus outcomes in pediatric patients undergoing disconnective hemispheric surgery for intractable epilepsy: a systematic review
2023, Canadian Journal of OphthalmologyThe impact of strabismus on psychosocial heath and quality of life: a systematic review
2021, Survey of OphthalmologyCitation Excerpt :Significant improvements can be seen in children with autism spectrum disorder and strabismus following surgical intervention, and parents note better social interaction, attention, self-confidence, verbal communication, eye contact, and eye-hand coordination following treatment [114]. For children with intermittent exotropia, decreased parental and proxy health-related quality of life are strongly associated with the decision to proceed with surgery [62]. Strabismus surgery in children can improve their psychosocial health and quality of life by maintaining normal psychosocial relationships between mothers and their children as well as other members of the family [3,76].
Intermittent exotropia
2016, Taylor and Hoyt's Pediatric Ophthalmology and Strabismus, Fifth EditionGoal-determined metrics to assess outcomes of exotropia surgery Presented as a poster at the 40th Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, Rancho Mirage, California, April 2-6, 2014.
2015, Journal of AAPOSCitation Excerpt :This confirms that, regardless of the methodology used to monitor postoperative motor alignment, binocular goals are harder to achieve. Prior publications31-33 have established that variable fusion and control of alignment in patients with intermittent exotropia, the dominant subpopulation, remains an outstanding clinical concern and reoperation is common. In addition to the methodology for monitoring motor alignment (SPCT vs APCT), fewer excellent outcomes for those seeking binocular goals may result from the narrower range of motor alignment, both at distance and at near, and the mandated sensory criteria for success.
Effectiveness of strabismus surgery on the health-related quality of life assessment of children with intermittent exotropia and their parents: A randomized clinical trial
2015, Journal of AAPOSCitation Excerpt :The reduced parental HRQOL might cause parents to seek further interventions for their children. Recently, Hatt and colleagues21 found that reduced parental and proxy HRQOL are associated with the decision to perform surgery and that recognizing parental concerns as independent of clinical severity may be important for managing childhood intermittent exotropia. Therefore, it is important for physicians to recognize reduced parental HRQOL and to provide more suggestions for managing intermittent exotropia, perhaps by providing the parents with more information about the current status and development of their child’s exotropia or by discussing the possible interventions with the parents and helping optimize their decision.
A randomized trial comparing part-time patching with observation for children 3 to 10 years of age with intermittent exotropia
2014, OphthalmologyCitation Excerpt :Conversely, considering them not to have deteriorated might have biased against finding an effect of patching if these participants eventually would have deteriorated had they not started nonrandomized treatment. These cases reflected clinician and parental concern about possible worsening of the IXT, concerns that may have been influenced by knowledge of the treatment group and that are often key factors in the decision to proceed with IXT surgery.33 In the fourth case, also in the observation group, a participant's excellent stereoacuity did not support the diagnosis of constant exotropia.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported by the National Institutes of Health, Bethesda, Maryland (grant no.: EY018810 [J.M.H.]); Research to Prevent Blindness, Inc, New York, New York (J.M.H. as Olga Keith Weiss Scholar and an unrestricted grant to the Department of Ophthalmology, Mayo Clinic); and the Mayo Foundation, Rochester, Minnesota. The funding organization had no role in the design or conduct of this research.