Associations between Health-Related Quality of Life and the Decision to Perform Surgery for Childhood Intermittent Exotropia

Abstract

Objective To assess associations between health-related quality of life (HRQOL) and the decision to perform strabismus surgery for children with intermittent exotropia (XT). Design Retrospective chart review Participants Children with intermittent XT Methods Included subjects, identified in a clinical practice, had assessment of HRQOL using the intermittent exotropia questionnaire (IXTQ), comprising Child, Proxy and Parent components (Parent domains: Function, Psychosocial, Surgery). IXTQ scores were evaluated for association with surgery, along with standard clinical measures: prism and alternate cover test (PACT), stereoacuity, and control score (mean of the 3 most recent scores). Included data were from preoperative (surgical cohort), or most recent follow-up (non-surgical cohort) examinations. Univariate and multivariate logistic regression analyses were performed and relative risk (RR) ratios calculated. Spearman rank correlations were calculated to identify highly correlated items. Main outcome measures Association of individual factors with the decision to perform surgery, calculated using relative risk ratios. Results 106 children with intermittent XT (median age 6, range 2 to 16 years) were eligible for inclusion. 19 (18%) of 106 underwent surgery. Using all available data, IXTQ Proxy score, IXTQ Parent-Function score, IXTQ Parent-Psychosocial score, distance control score, near control score, near PACT, and Preschool Randot stereoacuity were associated with undergoing surgery (P<0.1). 69 of 106 patients had complete data on all factors identified in univariate analysis and were included in multivariate analyses. 14 (20%) of these 69 underwent surgery. In multivariate analyses poor distance control score (RR 1.83, confidence interval [CI] 1.25, 2.68) and reduced IXTQ Parent-Function score (RR 0.96, CI 0.92, 0.99) were associated with surgical intervention. Repeat multivariate analyses retaining only one of highly correlated items showed IXTQ Proxy IXTQ Parent-Psychosocial, larger near PACT and worse near control were also associated with surgery. Conclusions After accounting for poorer exodeviation control at distance, reduced Parent and Proxy HRQOL were associated with undergoing strabismus surgery for childhood intermittent XT. Recognizing reduced parental HRQOL may be important, with a possible role for educational or counselling interventions.

Childhood intermittent exotropia from a different angle: does severity affect quality of life?

“…We found a positive correlation between proxy and parent scores in our Asian population of patients with IXT, which agrees with the findings of a previous study on a western population 17. This indicates that the more worried the parents thought their child might be, the more worried the parents themselves were.…”

“…This is similar to our finding in the child IXT population, suggesting a lack of correlation in both adults and children. Indeed, studies have found that children with IXT rarely report HRQOL concerns,11 16 and this has led to the question of whether the IXTQ is insensitive to the concerns of children 17. However, as the child IXTQ was derived from interviews of children with IXT, these studies are likely confirmatory.…”

“…Management of paediatric conditions such as childhood IXT is unique because parents’ views have a major influence in making decisions on treatment. Indeed, Hatt et al 17 found that reduced parent and proxy HRQOL but not child QOL is associated with the decision to do squint surgery for childhood IXT. This is not surprising as clinical reasons for offering surgery include large angle of deviation and decreasing control; if these factors contribute to greater parental worry and result in parents opting for surgery, it does make the decision between the clinician and the parent unanimous.…”

A Randomized Trial Comparing Part-Time Patching with Observation for Children 3 to 10 Years of Age with Intermittent Exotropia

“…These cases reflected clinician and parental concern about possible worsening of the IXT, concerns which may have been influenced by knowledge of the treatment group and which 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.…”

The health-related quality of life and anxiety for childhood intermittent exotropia before and after surgical correction

“…In this way, the clinical ndings of IXT in these children do not fully correspond with their mental health. Another indication of this difference between the children and their parents were the ndings that parents with poorer HRQOL score were more likely to make the decision to perform surgery [11] . Chiu et al [12] have suggested that the HRQOL should be incorporated into the post-operative evaluation.…”