Differences in quality-of-life dimensions of Adult Strabismus Quality of Life and Amblyopia & Strabismus Questionnaires

Abstract

PurposeThe Adult Strabismus Quality of Life Questionnaire (AS-20) and the Amblyopia & Strabismus Questionnaire (A&SQ) both measure health-related quality of life in strabismus patients. We evaluated to what extent these instruments cover similar domains by identifying the underlying quality-of-life factors of the combined questionnaires.MethodsParticipants were adults from a historic cohort with available orthoptic childhood data documenting strabismus and/or amblyopia. They had previously completed the A&SQ and were now asked to complete the AS-20. Factor analysis was performed on the correlation-matrix of the combined AS-20 and A&SQ data to identify common underlying factors. The identified factors were correlated with the clinical variables of angle of strabismus, degree of binocular vision, and visual acuity of the worse eye.ResultsOne hundred ten patients completed both questionnaires (mean age, 44 years; range, 38–51 years). Six factors were found that together explained 78% of the total variance. The factor structure was dominated by the first four factors. One factor contained psychosocial and social-contact items, and another factor depth-perception items from both questionnaires. A third factor contained seven items—only from the AS-20—on eye strain, stress, and difficulties with reading and with concentrating. A fourth factor contained seven items—only from the A&SQ—on fear of losing the better eye and visual disorientation, specific for amblyopia. Current visual acuity of the worse eye correlated with depth-perception items and vision-related items, whereas current binocular vision correlated with psychosocial and social-contact items, in 93 patients.ConclusionsFactor analysis suggests that the AS-20 and A&SQ measure a similar psychosocial quality-of-life domain. However, functional problems like avoidance of reading, difficulty in concentrating, eye stress, reading problems, inability to enjoy hobbies, and need for frequent breaks when reading are represented only in the AS-20. During the development of the A&SQ, asthenopia items were considered insufficiently specific for strabismus and were excluded a priori. The patients who generated the items for the AS-20 had, in majority, adulthood-onset strabismus and diplopia and were, hence, more likely to develop such complaints than our adult patients with childhood-onset strabismus and/or amblyopia.

Evaluation of vision screening in five‐ to eight‐year‐old children living in Region Västra Götaland, Sweden – a prospective multicentre study

“…The main purpose of vision screening is to prevent amblyopia, which is defined as decreased visual acuity (VA) in one or both eyes due to a disturbance of binocular and/ or foveal vision during development of the visual system (von Noorden 1985). Little is known about the impact of amblyopia on quality of life (Solebo et al 2015), but uncorrected ametropia in pre-schoolers is associated with a significant reduction in visual-motor function (Roch-Levecq et al 2008), and amblyopia due to strabismus in adults might cause eye stress and reading problems (van de Graaf et al 2017).…”

Implementing strabismus-specific psychosocial questionnaires in everyday clinical practice: mental health and quality of life in the context of strabismus surgery

“…In addition to the AS-20 Questionnaire as a quality-of-life measure, we also used the A&SQ. van de Graaf et al examined the differences between the two forms using factor analysis and found that both questionnaires examine similar QOL aspects, but the AS-20 Questionnaire assesses various functional complaints that are not found in the A&SQ 22…”

Inter-eye Differences in Ocular Biometric Parameters of Concomitant Exotropia

“…Some patients assume adaptive techniques to hide exotropia, such as placing their hair over the deviating eye ( 2 ). Adults with strabismus often have reduced quality of life ( 6 ), lower education levels, and fewer career choices ( 7 ).…”