Changes in health-related quality of life 1 year following strabismus surgery

Abstract

Purpose: To report changes in health-related quality of life (HRQOL) 1 year following strabismus surgery.

Design: Retrospective cohort study.

Methods: Seventy-three adults undergoing strabismus surgery in a single clinical practice completed the Adult Strabismus-20 (AS-20) HRQOL questionnaire preoperatively and at 6 weeks and 1 year postoperatively. All included adults were successfully aligned at 6 weeks postoperatively. Success was defined based on clinical criteria. Change in AS-20 psychosocial and function scores was evaluated as: 1) difference in scores between 6 weeks and 1 year postoperatively and 2) proportions exceeding previously published limits of agreement at 6 weeks and 1 year.

Results: For patients successfully aligned at both 6 weeks and 1 year (n=51), further improvement in median scores was seen from 6 weeks to 1 year for both the psychosocial scale (83.8 vs 93.8; P<.0001) and the function scale (72.5 vs 77.5; P=.007). Also, a greater proportion exceeded limits of agreement at 1 year than at 6 weeks (psychosocial: 48% vs 30%; P=.007, function: 67% vs 51%; P=.01). For patients who became partial success (n=18) or failure (n=4) at 1 year there was a numerical decrease in scores at 1 year.

Conclusions: Adult strabismus patients who remain successfully aligned show continued improvement in both psychosocial and function scores from 6 weeks to 1 year postoperatively, indicating that improvement in HRQOL is long-lasting. Evaluation of HRQOL should be considered when reporting strabismus surgery outcomes in clinical trials, and may prove helpful in assessing outcomes in clinical practice.

Figure 1

Psychosocial Adult Strabismus-20 (AS-20) scores pre-operatively, 6 weeks post-operatively and 1 year post-operatively in 71 adult strabismus patients successfully aligned at 6 weeks (overall, without regard to success status at 1 year). Scores improved further at 1 year, across all patients and for non-diplopic patients. Boxes represent 1^st quartile, median and 3^rd quartile values; whiskers represent extreme values. P value represents difference between 6 weeks and 1 year.

Figure 2

Psychosocial Adult Strabismus-20 (AS-20) scores pre-operatively, 6 weeks post-operatively and 1 year post-operatively in 71 adult strabismus patients successfully aligned at 6 weeks and sub-classified as success, partial success and failure at 1 year. For patients who remained successfully aligned at 1 year psychosocial scores improved further at 1 year. Boxes represent 1^st quartile, median and 3^rd quartile values; whiskers represent extreme values. P value represents difference between 6 weeks and 1 year.

Figure 3

Function Adult Strabismus-20 (AS-20) scores pre-operatively, 6 weeks postoperatively and 1 year post-operatively in 73 adult strabismus patients successfully aligned at 6 weeks (overall, without regard to success status at 1 year). Scores improved further at 1 year in non-diplopic patients. Boxes represent 1^st quartile, median and 3^rd quartile values; whiskers represent extreme values. P value represents difference between 6 weeks and 1 year.

Figure 4

Function Adult Strabismus-20 (AS-20) scores pre-operatively, 6 weeks postoperatively and 1 year post-operatively in 73 adult strabismus patients successfully aligned at 6 weeks and sub-classified as success, partial success and failure at 1 year. For patients who remained successfully aligned at 1 year, function scores improved further. Boxes represent 1^st quartile, median and 3^rd quartile values; whiskers represent extreme values. P value represents difference between 6 weeks and 1 year.