title: Associations between health-related quality of life and the decision to perform surgery for childhood intermittent exotropia.
abstract: OBJECTIVE
  To assess associations between health-related quality of life (HRQOL) and the decision to perform strabismus surgery for children with intermittent exotropia.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Children with intermittent exotropia.
  
  
  METHODS
  Included subjects, identified in a clinical practice, had assessment of HRQOL using the intermittent exotropia questionnaire (IXTQ), comprising child, proxy, and parent components (parent domains: function, psychosocial, and surgery). The IXTQ scores were evaluated for association with surgery, along with standard clinical measures: prism and alternate cover test (PACT), stereoacuity, and control score (mean of the 3 most recent scores). Included data were from preoperative examination (surgical cohort) or from most recent follow-up examination (nonsurgical cohort). Univariate and multivariate logistic regression analyses were performed, and relative risk (RR) ratios were calculated. Spearman rank correlations were calculated to identify highly correlated items.
  
  
  METHODS
  Association of individual factors with the decision to perform surgery, calculated using RR ratios.
  
  
  RESULTS
  One hundred six children with intermittent exotropia (median age, 6 years; range, 2-16 years) were eligible for inclusion. Nineteen (18%) of 106 underwent surgery. Using all available data, the IXTQ proxy score, IXTQ parent function score, IXTQ parent psychosocial score, distance control score, near control score, near PACT, and Randot Preschool stereoacuity (Stereoptical Co, Inc, Chicago, IL) were associated with undergoing surgery (P<0.1). Sixty-nine of 106 patients had complete data on all factors identified in univariate analysis and were included in multivariate analyses. Fourteen (20%) of these 69 patients underwent surgery. In multivariate analyses, poor distance control score (RR, 1.83; 95% confidence interval [CI], 1.25-2.68) and reduced IXTQ parent function score (RR, 0.96; 95% CI, 0.92-0.99) were associated with surgical intervention. Repeat multivariate analyses retaining only 1 of the highly correlated items showed IXTQ proxy, IXTQ parent psychosocial, larger near PACT, and worse near control were also associated with surgery.
  
  
  CONCLUSIONS
  After accounting for poorer exodeviation control at distance, reduced parent and proxy HRQOL were associated with undergoing strabismus surgery for childhood intermittent exotropia. Recognizing reduced parental HRQOL may be important, with a possible role for educational or counselling interventions.
authors: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors: Sarah R
authors: SR
authors: Hatt
authors: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors: David A
authors: DA
authors: Leske
authors: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors: Laura
authors: L
authors: Liebermann
authors: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors: Brian G
authors: BG
authors: Mohney
authors: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors: Michael C
authors: MC
authors: Brodsky
authors: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors: Tomohiko
authors: T
authors: Yamada
authors: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota. Electronic address: holmes.jonathan@mayo.edu.
authors: Jonathan M
authors: JM
authors: Holmes
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005099:Exotropia / Q000523:psychology* / Q000601:surgery*; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D008297:Male; D009801:Oculomotor Muscles / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D010290:Parents / Q000523:psychology; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D012307:Risk Factors; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D014792:Visual Acuity / Q000502:physiology