he Intermittent Exotropia Questionnaire (IXTQ) is a patientderived, intermittent exotropia-specific instrument designed to evaluate health-related quality of life (HRQOL) in children with intermittent exotropia and their parents. 1,2 The IXTQ consists of 3 parts: the 12-item child IXTQ (completed by the child to assess the child's HRQOL), the 12-item proxy IXTQ (completed by the parent to assess the child's HRQOL), and the 17-item parent IXTQ (completed by the parent regarding his or her own HRQOL). 1 The child and proxy questionnaires each have a single subscale. The parent questionnaire contains 3 subscales: psychosocial, function, and surgery. The IXTQ is reliable and valid for assessing HRQOL in children with intermittent exotropia. [1][2][3] It is available for download free of charge at http://pedig.jaeb.org/.The IXTQ was originally developed using classical test theory. Rasch analysis may be used to modify and improve existing HRQOL instruments. [4][5][6][7][8][9] In the present study, Rasch analysis was used to refine the existing IXTQ, removing items that do not contribute meaningful information to the instrument and ensuring that response options are properly interpreted. Methods Patient CohortParents gave written informed consent, and children gave written assent when required. The protocol was approved by the institutional review boards of the Mayo Clinic, Jaeb Center for Health Research, and other local sites involved in the study. Data were collected and analyzed in accordance with the Health Insurance Portability and Accountability Act guidelines. The IXTQ was completed by 575 parents of 575 children aged 1 through 16 years with intermittent exotropia at the time of their child's clinic examination, enrolled from May 15, 2008, through July 24, 2013. The 295 children aged 5 years or older completed the age-appropriate child IXTQ. Parents and children completed the IXTQ as part of routine care in the strabismus practice of one of the authors (J.M.H., n = 110) or at the enrollment examination for 1 of 2 ongoing randomized clinical trials being conducted by the Pediatric Eye Disease Investigator Group (NCT 01032603 [n = 69] and NCT 01032330 [n = 396]). Child questionnaires were administered to children aged 5 through 7 years by study personnel. All 8-to 17-year-old child, proxy, and parent questionnaires were self-administered. Patient demographics are reported in eTable 1 in the Supplement. Statistical AnalysisBefore Rasch analysis, items with floor and ceiling effects on the child, proxy, and parent IXTQs were eliminated as described in the eMethods in the Supplement. Rasch analysis was performed on each of the 4 IXTQs using the analytic methods that we have applied previously (eMethods in the Supplement). 9 The performance and structure of the Rasch-IMPORTANCE The Intermittent Exotropia Questionnaire (IXTQ) is a patient, proxy, and parental report of quality of life specific to children with intermittent exotropia. We refine the IXTQ using Rasch analysis to improve reliability and validity.OBSERVATI...
Infantile strabismus is significantly more common in children with CP than in the general pediatric population. Disorders of eye movements are also very common. Based on our experience and review of the literature there is no convincing evidence that vision therapy significantly improves eye movements or visual functioning. Approximately 2 of every 3 cases of nonaccommodative strabismus associated with CP can be successfully managed with conventional strabismus surgery, though most children will require at least two surgeries to achieve alignment.
The two most commonly used methods for determining the AC/A ratio are the Gradient Method and the Clinical Method. Though both methods are simple, practical, and often used interchangeably, they are really quite different. The Gradient AC/A measures the amount of convergence generated by a diopter of accommodative effort, while the Clinical Method detects the presence of a distance-near disparity of 10 or more prism diopters of esotropia. The purpose of this prospective study was to compare the Gradient and Clinical AC/A in 69 consecutive patients presenting with acquired nonparalytic esotropia. In addition, two methods of calculating the Gradient AC/A were compared: "minus" AC/A in which accommodation (and therefore accommodative convergence) is stimulated, and "plus" AC/A in which accommodation (and accommodative convergence) is relaxed. Mean Gradient AC/A for patients with a normal Clinical AC/A was 2:1, below the range traditionally thought of as normal. Mean Gradient AC/A for patients with a high Clinical AC/A was 5:1. Forty-four percent of those with a high Clinical AC/A had a normal or low Gradient AC/A, suggestive of nonaccommodative convergence excess. Mean Gradient AC/A with plus lenses was statistically identical to the AC/A with the minus lens method.
While children with CP are capable of age-appropriate acuity and binocular vision, they are at increased risk for sensory visual deficits. These deficits are not the direct result of CP itself, but either share a common underlying cause, or occur as sequelae to the strabismus that is prevalent in CP. Most importantly, some sensory deficits may respond to standard treatment methods.
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