title: The Psychosocial and Clinical Outcomes of Orbital Decompression Surgery for Thyroid Eye Disease and Predictors of Change in Quality of Life.
abstract: OBJECTIVE
  Thyroid eye disease (TED) has been found to reduce quality of life for many patients because of changes in their appearance and vision, although some seem to adjust better than others. This study was designed to investigate whether a patient's quality of life changes after having orbital decompression for improvement of appearance, vision, or both, and whether any demographic, clinical, or psychosocial factors can predict which patients might benefit from this surgery.
  
  
  METHODS
  This study used a within-subjects repeated-measures design, in which patients were assessed before and at 6 weeks and 6 months after surgery.
  
  
  METHODS
  A total of 123 adults (aged >18 years) with TED and undergoing orbital decompression surgery were recruited at Moorfields Eye Hospital.
  
  
  METHODS
  Participants received lateral wall, medial wall, 2.5 wall, or 3 wall decompression and were followed up after surgery with a range of psychosocial and clinical assessments.
  
  
  METHODS
  The Graves' Ophthalmopathy Quality of Life (GO-QOL) scale was completed at each time point, and this was used as the dependent variable in each hierarchical multiple regression model.
  
  
  RESULTS
  Significant improvements were found in all clinical characteristics after orbital decompression and in most psychosocial variables. The GO-QOL visual function scores did not change significantly until 6 months after surgery. In contrast, GO-QOL appearance scores changed significantly by 6 weeks after surgery and continued to increase to 6 months, reaching a minimal clinically important difference for this scale. None of the changes in clinical or psychosocial outcomes significantly predicted change in GO-QOL visual function. However, the hierarchical regression model explained 79% of the variance in change in GO-QOL appearance, with change in subjective evaluation of appearance being the only unique predictor of change in appearance-related quality of life.
  
  
  CONCLUSIONS
  This study highlights the importance of appearance-related cognitions in predicting quality of life outcomes after surgery. Implications for clinical practice need to be considered in light of the limitations of this study, but it is suggested that psychosocial interventions targeting appearance-related cognitive processes, in particular personal evaluation of appearance, could enhance the quality of life outcomes for patients with TED undergoing orbital decompression surgery.
authors.affiliation: City University London, School of Health Sciences, London, United Kingdom; Moorfields Eye Hospital, London, United Kingdom.
authors.forename: Sadie
authors.initials: S
authors.lastname: Wickwar
authors.affiliation: City University London, School of Health Sciences, London, United Kingdom; East London Foundation Trust, London, United Kingdom.
authors.forename: Hayley
authors.initials: H
authors.lastname: McBain
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, NIHR Biomedical Research Centre for Ophthalmology, London, United Kingdom.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Ezra
authors.affiliation: City University London, School of Health Sciences, London, United Kingdom.
authors.forename: Shashivadan P
authors.initials: SP
authors.lastname: Hirani
authors.affiliation: Moorfields Eye Hospital, London, United Kingdom; UCL Institute of Ophthalmology, NIHR Biomedical Research Centre for Ophthalmology, London, United Kingdom.
authors.forename: Geoffrey E
authors.initials: GE
authors.lastname: Rose
authors.affiliation: City University London, School of Health Sciences, London, United Kingdom. Electronic address: Stanton.newman.1@city.ac.uk.
authors.forename: Stanton P
authors.initials: SP
authors.lastname: Newman
mesh_terms: D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D005260:Female; D049970:Graves Ophthalmopathy / Q000523:psychology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000601:surgery*; D011584:Psychology; D011788:Quality of Life / Q000523:psychology*; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D055815:Young Adult