Symptoms in Children with Intermittent Exotropia and Their Impact on Health-Related Quality of Life

Abstract

Purpose In childhood intermittent XT the frequency and type of symptoms has not been rigorously studied. We aimed to identify specific symptoms in children with intermittent XT, their frequency, and effects on health-related quality of life (HRQOL). Methods 35 children (5–13 years) with intermittent XT, without previous surgery were enrolled in a prospective cohort study. Specific symptoms were identified from a previous study involving child and parent interviews and formulated as a 22-item symptom questionnaire. A frequency Likert-type rating scale was used and a response of “sometimes” or more was considered consistent with having the symptom. All 35 children, along with one parent for each child, also completed the patient-derived intermittent XT HRQOL questionnaire (IXTQ) with Child, Proxy and Parent components. The frequency of symptoms was calculated, and the relationship between individual symptom question scores and Child, Proxy and Parent HRQOL scores, was evaluated in multivariate linear regression analyses. Results The mean number of specific symptoms was 7 (range 2 to 19). The most frequently reported were: rubbing the eye (29 [83%] of 35), problems with eyes in the sun and the eyes feeling tired (each 22, 63%). Lower (worse) Child IXTQ HRQOL scores were associated with symptoms of difficulty focusing eyes (P=0.0007), double vision (P=0.007), eyes hurting (P=0.006), and problems with eyes in the sun (P=0.06). There were weak associations between Proxy IXTQ and Parent IXTQ scores and child symptoms. Overall, 7 symptom questions were associated with reduced HRQOL in multivariate models. Conclusion Children with intermittent XT frequently experience symptoms, some of which impact the child’s HRQOL. Formal assessment of symptoms may aid understanding of the effects of intermittent XT on an individual child, and could use just the seven symptom questions associated with reduced HRQOL.

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

“…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.…”

Preoperative Variables Associated with Surgical Outcome for the Correction of Exodeviation

“…Findings include one or either eye deviating outward some of the time, diplopia, headaches, photophobia/photalgia, closing or winking of one or either eye, or reduced binocular visual acuity [ 5 , 6 , 7 ]. Clinical assessment for this condition includes visual acuity, binocular functions, prism diopter (pd) measurements, assessments of control, classification of exodeviation and the presence of pattern deviations [ 1 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Both symptoms and assessment outcomes may be used to determine the need for surgery in this population and are important considerations prior to intervention [ 1 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

Maintenance of normal fusion in intermittent exotropia

“…2,3,6 Symptoms of intermittent exotropia include concerns about cosmesis, 9 intermittent diplopia, tired eyes, excessive blinking and reduced quality of life. 10,11 The management of intermittent exotropia includes both surgical and nonsurgical treatment options (i.e., watchful observation, patching, prisms, over-minus lenses and vision therapy/ orthoptics). [12][13][14][15] In recent years, a number of randomised clinical trials have been performed to study the effectiveness of both surgical 16 and non-surgical 17,18 treatment of intermittent exotropia, and various outcome measures have been used in these studies.…”

“…Intermittent exotropia is a common form of strabismus 1–8 with an estimated prevalence of 0.5%–3.3% in children 2,3,6 . Symptoms of intermittent exotropia include concerns about cosmesis, 9 intermittent diplopia, tired eyes, excessive blinking and reduced quality of life 10,11 . The management of intermittent exotropia includes both surgical and non‐surgical treatment options (i.e., watchful observation, patching, prisms, over‐minus lenses and vision therapy/orthoptics) 12–15 …”