Objective: To analyze the health-related quality of life (HRQOL) in adults with strabismus, and to identify the factors that affect the HRQOL in strabismus patients. Methods: In this investigation study, 202 adults with strabismus and 110 healthy control adults were recruited. Participants were asked to complete the Chinese Adult Strabismus 20 scale (CAS-20) HRQOL assessment. The following individual information was recorded: type and degree of strabismus, diplopia, age, sex, and marital status. Independent samplest-tests, ANOVA, Pearson correlation analyses, multiple linear regression analyses were used to analyze the effects of strabismus on HRQOL in adults based on the CAS-20 score. Results: The mean CAS-20 score for strabismus adults was 56.8±16.7, while the score in the control group was 98.0±4.3 (t=-35.2,P<0.001). The CAS-20 function score of patients with diplopia was significantly lower than that for patients without it (t=-1.987, P=0.047). The CAS-20 mean scores were all significantly lower in patients with amblyopia (t=-2.122, P=0.004). The psychosocial score of patients with a large horizontal strabismus(>25△) was significantly lower than those with a small horizontal strabismus (≤25△) (t=2.523, P=0.007).There were no significant differences among the different types of strabismus. Age and the course of strabismus were negatively correlated with the HRQOL in strabismus adults (r=-0.260, P < 0.001; r=
-0.142, P=0.035). Married strabismus subjects had lower scores than unmarried subjects (t=2.981, P=0.004). Patients who were students had higher scores (t=-2.084, P=0.038). A multifactor retrospective analysis showed that age and the course of the strabismus, with or without amblyopia, were the main factors affecting the HRQOL for strabismic adults. Conclusions: The HRQOL of adults with strabismus is worse than that for healthy adults. The CAS-20 function scores of patients with diplopia or amblyopia are significantly lower than for patients without diplopia or amblyopia. The course of strabismus, age and with or without amblyopia are important factors in HRQOL.
陈园园,李以跑,许梅萍,余新平. 成人斜视患者术前生存质量的研究[J]. 中华眼视光学与视觉科学杂志, 2017, 19(7): 406-412.
Yuanyuan Chen,Yipao Li,Meiping Xu,Xinping Yu. The Effects of Strabismus on Health-related Quality of Life in Adults. Chinese Journal of Optometry Ophthalmology and Visual science, 2017, 19(7): 406-412. DOI: DOI:10.3760/cma.j.issn.1674-845X.2017.07.005
Satterfield D, Keltner JL, Morrison TL. Psychosacial aspects of strabismus study. Arch Ophthalmol,1993, 111(8): 1100-1105. [3] Xu J, Yu X, Huang Y, et al. The psychosocial effects of strabismus before and after surgical correction in Chinese adolescents and adults. J Pediatr Ophthalmol Strabismus, 2012,
49
(3): 170-175. DOI: 10.3928/01913913-20110920-02.
[4]
Goff MJ, Suhr AW, Ward JA, et al. Effect of adult strabismus on ratings of official U.S. Army photographs. J AAPOS, 2006, 10(5): 400-403. DOI: 10.1016/j.jaapos.2006.04.011.
[5]
Hatt SR, Leske DA, Kirgis PA, et al. The effects of strabismus on quality of life in adults. Am J Ophthalmol, 2007, 144(5):643-647. DOI: 10.1016/j.ajo.2007.06.032.
[6]
Hatt SR, Leske DA, Liebermann L, et al. Depressive symptoms associated with poor health-related quality of life in adults with strabismus. Ophthalmology, 2014, 121(10): 2070-2071. DOI:10.1016/j.ophtha.2014.04.031.
McKenzie JA, Capo JA, Nusz KJ, et al. Prevalence and sex differences of psychiatric disorders in young adults who had intermittent exotropia as children. Arch Ophthalmol, 2009,
Mojon-Azzi SM, Mojon DS. Strabismus and employment: the opinion of headhunters. Acta Ophthalmol, 2009, 87(7): 784-788.DOI: 10.1111/j.1755-3768.2008.01352.x.
[10]
Coats DK, Paysse EA, Towler AJ, et al. Impact of large angle horizontal strabismus on ability to obtain employment.Ophthalmology, 2000, 107(2): 402-405.
[11]
Paysse EA, Steele EA, McCreery KM, et al. Age of the emergence of negative attitudes toward strabismus. J AAPOS,2001, 5(6): 361-366. DOI: 10.1067/mpa.2001.119243.
[12]
Olitsky SE, Sudesh S, Graziano A, et al. The negative psychosocial impact of strabismus in adults. J AAPOS, 1999,3(4): 209-211.
[13]
McBain HB, MacKenzie KA, Au C, et al. Factors associated with quality of life and mood in adults with strabismus. Br J Ophthalmol, 2014, 98(4): 550-555. DOI:10.1136/bjophthalmol-2013-304220.
[14]
叶婷, 中文版成人斜视患者生存质量量表的评价和应用. 温州: 温州医科大学, 2012.
[15]
Hatt SR, Leske DA, Bradley EA, et al. Development of a qualityof-life questionnaire for adults with strabismus. Ophthalmology,2009, 116(1): 139-144.e5. DOI: 10.1016/j.ophtha.2008.08.043.
[16]
Hatt SR, Leske DA, Holmes JM. Responsiveness of healthrelated quality-of-life questionnaires in adults undergoing Strabismus surgery. Ophthalmology, 2010, 117(12): 2322-2328.e1. DOI: 10.1016/j.ophtha.2010.03.042.
[17]
Glasman P, Cheeseman R, Wong V, et al. Improvement in patients' quality-of-life following strabismus surgery: evaluation of postoperative outcomes using the Adult Strabismus 20(AS-20) score. Eye (Lond), 2013, 27(11): 1249-1253. DOI: 10.1038/eye. 2013.174.
[18]
Durnian JM, Owen ME, Baddon AC, et al. The psychosocial effects of strabismus: effect of patient demographics on the AS-20 score. J AAPOS, 2010, 14(6): 469-471. DOI: 10.1016/j.jaapos.2010.08.013.
[19]
McBain HB, Au CK, Hancox J, et al. The impact of strabismus on quality of life in adults with and without diplopia: a systematic review. Surv Ophthalmol, 2014, 59(2): 185-191.
DOI: 10.1016/j.survophthal.2013.04.001.
[20]
Wen G, McKean-Cowdin R, Varma R, et al. General healthrelated quality of life in preschool children with strabismus or amblyopia. Ophthalmology, 2011, 118(3): 574-580. DOI: 10.1016/j.ophtha.2010.06.039.
[21]
Strahan EJ, Wilson AE, Cressman KE, et al. Comparing to perfection: How cultural norms for appearance affect social comparisons and self-image. Body Image, 2006, 3(3): 211-227.DOI: 10.1016/j.bodyim.2006.07.004.