title: Which factors are associated with quality of life in patients with Graves' orbitopathy presenting for orbital decompression surgery?
abstract: OBJECTIVE
  Graves' orbitopathy (GO) is associated with changes in the appearance of the eyes and visual dysfunction. Patients report feeling socially isolated and unable to continue with day-to-day activities. This study aimed at investigating the demographic, clinical, and psychosocial factors associated with quality of life in patients presenting for orbital decompression surgery.
  
  
  METHODS
  One-hundred and twenty-three adults with GO due for orbital decompression at Moorfields Eye Hospital London were recruited prospectively. Clinical measures including treatment history, exophthalmos, optic neuropathy, and diplopia were taken by an ophthalmologist. Participants completed psychosocial questionnaires, including the Graves' Ophthalmopathy Quality of Life Scale (GO-QOL), the Hospital Anxiety and Depression Scale, and the Derriford Appearance Scale. Hierarchical multiple regression analyses were used to identify predictors of quality of life.
  
  
  RESULTS
  Higher levels of potential cases of clinical anxiety (37%) and depression (26%) were found in this study sample than in patients with other chronic diseases or facial disfigurements. A total of 55% of the variance in GO-QOL visual function scores was explained by the regression model; age, asymmetrical GO and depressed mood were significant unique contributors. In all, 75% of the variance in GO-QOL appearance scores was explained by the regression model; gender, appearance-related cognitions and depressed mood were significant unique contributors.
  
  
  CONCLUSIONS
  Appearance-related quality of life and mood were particularly affected in this sample. Predominantly psychosocial characteristics were associated with quality of life. It is important when planning surgery for patients that clinicians be aware of factors that could potentially influence outcomes.
authors.affiliation: 1] Centre for Health Services Research, School of Community & Health Sciences, City University London, London, UK [2] Adnexal Department, Moorfields Eye Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Wickwar
authors.affiliation: 1] Centre for Health Services Research, School of Community & Health Sciences, City University London, London, UK [2] Community Health Newham, East London Foundation Trust, London, UK.
authors.forename: H B
authors.initials: HB
authors.lastname: McBain
authors.affiliation: 1] Adnexal Department, Moorfields Eye Hospital, London, UK [2] UCL Institute of Ophthalmology, NIHR Biomedical Research Centre for Ophthalmology, London, UK.
authors.forename: D G
authors.initials: DG
authors.lastname: Ezra
authors.affiliation: Centre for Health Services Research, School of Community & Health Sciences, City University London, London, UK.
authors.forename: S P
authors.initials: SP
authors.lastname: Hirani
authors.affiliation: 1] Adnexal Department, Moorfields Eye Hospital, London, UK [2] UCL Institute of Ophthalmology, NIHR Biomedical Research Centre for Ophthalmology, London, UK.
authors.forename: G E
authors.initials: GE
authors.lastname: Rose
authors.affiliation: Centre for Health Services Research, School of Community & Health Sciences, City University London, London, UK.
authors.forename: S P
authors.initials: SP
authors.lastname: Newman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D019299:Decompression, Surgical; D005006:Ethnicity; D005260:Female; D049970:Graves Ophthalmopathy / Q000523:psychology* / Q000601:surgery*; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D012737:Sex Factors; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D055815:Young Adult