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. 2020 May 1;138(5):528-535.
doi: 10.1001/jamaophthalmol.2020.0539.

Association of Strabismus With Functional Vision and Eye-Related Quality of Life in Children

Sarah R Hatt  1 , David A Leske  1 , Yolanda S Castañeda  2 , Suzanne M Wernimont  1 , Laura Liebermann  1 , Christina S Cheng-Patel  2 , Eileen E Birch  2   3 , Jonathan M Holmes  1
Affiliations

Association of Strabismus With Functional Vision and Eye-Related Quality of Life in Children

Sarah R Hatt et al. JAMA Ophthalmol. .

Abstract

Importance: Strabismus is common, affecting 2% to 4% of children, but how children and their families are affected in everyday life is poorly understood.

Objective: To evaluate the association of strabismus with functional vision and eye-related quality of life in children and their families using the Pediatric Eye Questionnaire (PedEyeQ).

Design, setting, and participants: This cross-sectional study was conducted between December 2017 and October 2019 and included 91 children with strabismus and 166 visually normal controls across 3 age groups (0-4, 5-11, and 12-17 years) who were enrolled at Mayo Clinic, Rochester, Minnesota, and Retina Foundation of the Southwest, Dallas, Texas.

Exposures: Children completed the child PedEyeQ (5 to 11- and 12 to 17-year versions: functional vision, bothered by eyes/vision, social, and frustration/worry domains); parents completed the proxy (0 to 4-, 5 to 11-, and 12 to 17-year versions: functional vision, bothered by eyes/vision, social, frustration/worry, and eye care domains) and the parent PedEyeQ (impact on parent and family, worry about child's eye condition, worry about child's self-perception and interactions, and worry about child's functional vision domains). Rasch-calibrated PedEyeQ scores were calculated for each domain and converted to 0 (worst) to 100.

Main outcomes and measures: PedEyeQ domain scores.

Results: Of 91 participants with strabismus, 41 (45.1%) were girls, 74 (81.3%) were white, 4 (4.4%) were Asian, 5 (5.5%) were more than 1 race, 5 (5.5%) were African American, and 2 (2.2%) were American Indian/Alaska Native. Child PedEyeQ domain scores were lower with strabismus vs visually normal controls among children ages 5 to 11 years and the greatest mean (SD) difference was in functional vision (12 [14] points; 95% CI, 6-18; P = .001), and among children ages 12 to 17 years, the greatest mean (SD) difference was in frustration/worry (27 [13] points; 95% CI, 18-36; P < .001). Proxy PedEyeQ domain scores were also lower with strabismus. The greatest difference among children ages 0 to 4 years was in functional vision (13 [9] points; 95% CI, 9-16; P < .001), among children ages 5 to 11 years was in functional vision (26 [10] points; 95% CI, 22-30; P < .001); and among children ages 12 to 17 years was in functional vision (21 [12] points; 95% CI, 12-30; P < .001), social (21 [13] points; 95% CI, 12-30; P < .001), and frustration/worry (21 [13] points; 95% CI, 12-30; P < .001). Parent PedEyeQ domain scores were lower with strabismus; the greatest difference was in worry about child's eye condition (38 [14] points; 95% CI, 34-42; P < .001).

Conclusions and relevance: Strabismus is associated with reduced functional vision and eye-related quality of life in children. Parents of children with strabismus also experience a reduced quality of life. These findings advance our understanding of how strabismus affects children and their families and should be considered when defining patient management goals.

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Conflict of interest statement

Conflict of Interest Disclosures: Mss Hatt, Liebermann, and Wernimont, Mr Leske, and Dr Holmes reported grants from the National Eye Institute and Mayo Foundation. Mss Castañeda and Cheng-Patel and Dr Birch reported grants from National Eye Institute. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Child Pediatric Eye Questionnaire (PedEyeQ) Domain Scores in Children With Strabismus and in Normal Controls
A, PedEyeQ scores for children ages 5 to 11 years (functional vision, bothered by eyes/vision, social, and frustration/worry). B, PedEyeQ scores for children ages 12 to 17 years (functional vision, bothered by eyes/vision, social, and frustration/worry). The boxes represent the first quartile, median, and third quartile values; whiskers represent extreme values.
Figure 2.
Figure 2.. Proxy Pediatric Eye Questionnaire (PedEyeQ) Domain Scores in Children With Strabismus and in Normal Controls
A, Proxy PedEyeQ scores for children ages 0 to 4 years (functional vision, bothered by eyes/vision, and social). B, Proxy PedEyeQ scores for children ages 5 to 11 years (functional vision, bothered by eyes/vision, social, frustration/worry, and eye care). C, Proxy PedEyeQ scores for children ages 12 to 17 years (functional vision, bothered by eyes/vision, social, frustration/worry, and eye care). The boxes represent the first quartile, median, and third quartile values; whiskers represent extreme values.
Figure 3.
Figure 3.. Parent Pediatric Eye Questionnaire (PedEyeQ) Domain Scores in Children With Strabismus and in Normal Controls
Parent PedEyeQ domains include the impact on parent and family, worry about child’s eye condition, worry about child’s self-perception and interactions, and worry about child’s functional vision. The boxes represent first quartile, median, and third quartile values; whiskers represent extreme values.
Figure 4.
Figure 4.. Pediatric Eye Questionnaire (PedEyeQ) Domain Scores in Children With Strabismus Without Current Amblyopia, Current Eyeglasses, or Previous Strabismus Surgery and in Normal Controls
A, Child PedEyeQ scores for children ages 5 to 11 years (functional vision, bothered by eyes/vision, social, and frustration/worry). B, Proxy PedEyeQ scores for children ages 5 to 11 years (functional vision, bothered by eyes/vision, social, frustration/worry, and eye care). C, Parent PedEyeQ (impact on parent and family, worry about child’s eye condition, worry about child’s self-perception and interactions, and worry about child’s functional vision). The boxes represent first quartile, median, and third quartile values; whiskers represent extreme values.
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