title: The psychological impact of strabismus: does the angle really matter?
abstract: BACKGROUND
  The psychological impact of strabismus is well recognized. Patients with strabismus have lower levels of psychological well being compared to normal controls. Few studies have evaluated the relationship between levels of psychological distress and the angle of deviation, age, sex, presence of diplopia, visual acuity and direction of deviation.
  
  
  METHODS
  50 patients with strabismus who attended the adult strabismus clinic were included in this questionnaire based prospective study. The Psychological Impact questionnaire was used to assess the psychological impact of noticeable strabismus. We measured the angle of deviation, age, sex, presence of diplopia, visual acuity and direction of deviation and correlated these with psychological impact scores. Student's t-test and Pearson's correlation coefficient (r) were used in statistical analysis.
  
  
  RESULTS
  The average age was 48 years (range 15-84) and there were 26 females and 24 males. There was no correlation between psychological impact score and the maximum degree of horizontal deviation r = 0.02 (95% CI -0.26 to 0.29), p = 0.9, the maximum angle of vertical deviation r = 0.26 (95% CI -0.01 to 0.51), p = 0.06, age r = -0.09 (95% CI -0.36 to 0.19), p = 0.5, sex (p = 0.96), presence of diplopia (p = 0.6), visual acuity of the worse eye r = -0.01 (95% CI -0.29 to 0.27), p = 0.9 and direction of deviation (p = 0.8 for eso-deviations compared to exo-deviations, p = 0.4 for horizontal compared to vertical deviations). There was a slight negative correlation between psychological impact score and visual acuity of the better eye r = -0.28 (95% CI -0.52 to -0.01), p = 0.04.
  
  
  CONCLUSIONS
  The psychological impact of strabismus does not appear to be related to the patient's angle of deviation, age, sex, presence of diplopia, visual acuity or direction of deviation. Larger studies are required using strabismus specific tools for evaluating psychological impact to further investigate these findings.
authors.affiliation: Royal Free Hospital, Ophthalmology , London , UK.
authors.forename: Ailsa
authors.initials: A
authors.lastname: Ritchie
authors.forename: Patricio
authors.initials: P
authors.lastname: Colapinto
authors.forename: Saurabh
authors.initials: S
authors.lastname: Jain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005133:Eye Movements / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology*; D013508:Ophthalmologic Surgical Procedures / Q000523:psychology; D011379:Prognosis; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D013285:Strabismus / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery; D011795:Surveys and Questionnaires; D014792:Visual Acuity; D055815:Young Adult