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

Lim, Shin Bin; Wong, Wan Ling; Ho, Roger; Wong, Inez B.

doi:10.1136/bjophthalmol-2014-306545

Cited by 22 publications

(15 citation statements)

References 23 publications

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“…Our analysis showed that the angle of deviation had no effect on intelligence in exotropia children. This finding is in line with the previous observation that there is no correlation between deviation severity and psychological parameters in exotropia patients [38]. During the pathogenesis of exotropia, the stereoacuity, control, and angle of deviation are unstable, and exotropia children may exhibit any combination of stereoacuity, control, and angle of deviation [39].…”

Section: Discussionsupporting

confidence: 91%

Characterization of Intelligence in Children with Exotropia

Sun

Wang

Shen

et al. 2019

IJERPH

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The effect of exotropia on the intelligence of children is unknown. This study aimed to assess the intelligence in children with exotropia and investigate the influence of the main clinical indexes of strabismus on intelligence. Eighty-four participants aged 8–12 years were enrolled, including 37 patients with exotropia (exotropia group) and 47 normal individuals (normal group). Intelligence was assessed by the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV), including the Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), Processing Speed Index (PSI), and Full-Scale Intelligence Quotient (FSIQ). The exotropia group had a significantly lower PRI score but a higher PSI score than the normal group. However, there was no significant difference in the WMI, VCI, and FSIQ between groups. Multiple linear regression showed that PRI–WMI and PRI–PSI differences were significantly lower in the exotropia group. Inter-subscale correlations analysis showed that the pattern of intelligence structure was different between groups. The type of exotropia, angle of deviation, duration of symptoms, and stereoacuity had no effect on the intelligence of children with exotropia. Children with exotropia had a relatively worse performance in the perceptual reasoning skill but a better processing speed and a different pattern of intelligence structure.

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Section: Discussionsupporting

confidence: 91%

Characterization of Intelligence in Children with Exotropia

Sun

Wang

Shen

et al. 2019

IJERPH

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“…However, in that study a wide variety of strabismus types were included in their analysis. In the Wang et al's study, the deviation angle at distance and exotropia control at home were associated with the child's HRQOL [22] , while Lim et al believed that the child's HRQOL and clinical severity were not related [10]. Our current results were mixed, that is, the child's IXTQ was related to near stereoacuity, but not to the deviation angle, NSC and distant stereoacuity.…”

Section: Discussioncontrasting

confidence: 52%

“…In general, the more severe the IXT, the worse the HRQOL. However, Hatt and Lim [9,10] found that while parents' HRQOL was related to the children's IXT severity, no such relationship was present in the children. In this way, the clinical ndings of IXT in these children do not fully correspond with their mental health.…”

Section: Introductionmentioning

confidence: 96%

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

Mao

Lin

Chen

et al. 2020

Preprint

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Purposes:To assess the health-related quality of life (HRQOL) and hospital anxiety and depression scale (HADS) in Chinese children with intermittent exotropia (IXT) before and after strabismus surgery.Patients and Methods: The records of children with IXT who underwent strabismus surgery at the Zhongshan Ophthalmic Center, of Sun Yat-sen University, China over the period from January 1, 2016 to December 31, 2018 were retrospectively reviewed. All children underwent ophthalmic and orthoptic examinations including the prism and alternate cover test, fusion function by synoptophore, stereoacuity and Newcastle control score. With use of the Intermittent Exotropia Questionnaire (IXTQ), the pre- and post-operative HRQOL and pre-operative HADS were assessed within these children and their parents.Results: A total of 389 children were eligible for inclusion (47.8% male, 52.2% female, mean + SD age = 8.17 ± 2.81). Pre-operative IXTQ scores in both children and their parents were significantly correlated with near stereoacuity (P = 0.029 and P = 0.015, respectively). The angle of deviation at near vision showed a negative linear relationship with visual function (P = 0.026) and psychological (P = 0.019) scores and opinions regarding surgery(P = 0.024). HADS scores were also related with near stereoacuity (P < 0.05). After surgery, both children’s and parents’ IXTQs significantly improved (p༜0.01). Children’ IXTQ scores were related to the angle of deviation at distance and their psychological and visual function scores showed a negative relationship with the angle of deviation at near vision (P < 0.05).Conclusion: Children and parents HRQOL and HADS were associated with near stereoacuity. Parents usually attend more readily to the angle of deviation at near in their IXT children. HRQOL improved significantly after surgery and can be used as one of the indices for pre-operative evaluation, but is not recommended as a criteria for surgical intervention.These first two authors contributed equally to this work

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“…However, in that study, a wide variety of strabismus types were included in the analysis. In Wang et al’s study, the deviation angle at distance and exotropia control at home were associated with the child’s HRQOL [ 22 ], whereas Lim et al believed that the child’s HRQOL and clinical severity were not related [ 10 ]. Our current results were mixed; that is, the child’s IXTQ was related to near stereoacuity but not to the deviation angle, NSC or distant stereoacuity.…”

Section: Discussionmentioning

confidence: 99%

“…In general, the more severe the IXT, the worse the HRQOL. However, Hatt and Lim [ 9 , 10 ] found that whereas parents’ HRQOL was related to children’s IXT severity, no such relationship was present in the children. In this way, the clinical findings of IXT in these children do not fully correspond with their mental health.…”

Section: Introductionmentioning

confidence: 99%

Health-related quality of life and anxiety associated with childhood intermittent exotropia before and after surgical correction

et al. 2021

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Background Intermittent exotropia (IXT) is the most common form of exotropia in children. In addition to cosmetic effects and loss of stereoscopic function, IXT may negatively impact the psychological well-being of children and their parents. The purpose of this study was to assess the patient-reported outcomes of Chinese children with IXT before and after strabismus surgery. Methods The records of children with IXT who underwent strabismus surgery at the Zhongshan Ophthalmic Center of Sun Yat-sen University, China over the period from January 1, 2016 to December 31, 2018 were prospectively recruited. All children underwent ophthalmic and orthoptic examinations, including the prism and alternate cover test, fusion function by synoptophore, stereoacuity and Newcastle control score. Two patient-reported outcome measures were used: the intermittent Exotropia Questionnaire (IXTQ) to measure disease-specific health-related quality of life (HRQOL) and the Hospital Anxiety and Depression Scale (HADS) to measure anxiety and depression. Patient-reported outcome measurements were made before and after surgery with responses from children and their parents. Results A total of 389 children were eligible for inclusion (47.8% male, 52.2% female, mean + SD age = 8.17 ± 2.81). Preoperative IXTQ scores in both children (48.21 ± 26.2) and their parents (44.6 ± 25.68) were significantly correlated with near stereoacuity (P = 0.029 and P = 0.015, respectively). The angle of deviation at near vision showed a negative linear relationship with visual function (P = 0.026) and psychological (P = 0.019) scores as well as opinions regarding surgery (P = 0.024). HADS scores (anxiety scale score: 11 ± 2.92, depression scale score: 10.44 ± 2.9) were also related to near stereoacuity (P < 0.05). After surgery, both children’s (74.83 ± 16.59) and parents’ (68.57 ± 17.06) IXTQ scores significantly improved (p<0.01). Children’s IXTQ scores were related to the angle of deviation at distance, and their psychological and visual function scores showed a negative relationship with the angle of deviation at near vision (P < 0.05). Conclusion Children and parents’ HRQOL and HADS were associated with near stereoacuity. Parents usually attend more readily to the angle of deviation at near in their IXT children. HRQOL improved significantly after surgery and can be used as one of the indices for preoperative evaluation but is not recommended as a criterion for surgical intervention.

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

Cited by 22 publications

References 23 publications

Characterization of Intelligence in Children with Exotropia

Characterization of Intelligence in Children with Exotropia

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

Health-related quality of life and anxiety associated with childhood intermittent exotropia before and after surgical correction

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