Original article
Comparison of Quality-of-Life Instruments in Adults with Strabismus

https://doi.org/10.1016/j.ajo.2009.05.009Get rights and content

Purpose

To compare two health-related quality-of-life (HRQOL) questionnaires in adults with strabismus: the new 20-item Adult Strabismus (AS-20) questionnaire (developed specifically for Adult Strabismus) and the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25).

Design

Cross-sectional study.

Methods

Eighty-four adult patients with strabismus (median age, 53 years; range, 18 to 81 years) completed the AS-20 and VFQ-25 HRQOL questionnaires. Patients were categorized as diplopic (n = 65) or nondiplopic (n = 19). Subnormal HRQOL was defined as less than the fifth percentile for adults with no visual impairment. The proportion of patients below normal was compared overall and by diplopia status.

Results

Overall, more patients scored below normal with the AS-20 than with the VFQ-25 (90% vs 29%; P < .0001). Nondiplopic patients more often were below normal on the AS-20 psychosocial subscale than on the function subscale (95% vs 42%; P = .002), whereas diplopic patients were more often below normal on the function subscale (85% vs 68%; P = .01). On the psychosocial subscale, more nondiplopic than diplopic patients scored below normal (95% vs 68%; P = .01); on the function subscale, more diplopic than nondiplopic patients scored below normal (85% vs 42%; P = .0005). The VFQ-25 seemed to be insensitive to nondiplopic strabismus: no patients scored below normal on composite score and no more than 11% scored below normal on VFQ-25 subscales. Of diplopic patients, 37% scored below normal on VFQ-25 composite score. No more than 38% scored below normal on VFQ-25 subscales.

Conclusions

The new AS-20 seems to be more sensitive than the VFQ-25 for detecting reduced HRQOL in Adult Strabismus, and therefore may be a more useful tool for clinical assessment and clinical trials.

Section snippets

Methods

The AS-20 consists of 20 questions with two established subscales: psychosocial (10 items) and function (10 items).4 For each AS-20 questionnaire item, a 5-point Likert-type scale is used for responses: never (score 100), rarely (score 75), sometimes (score 50), often (score 25), and always (score 0).4 The VFQ-25 consists of 25 questions in 12 subscales: general health, general vision, ocular pain, near activities, distance activities, vision-specific social function, vision-specific mental

All Strabismus Patients

More patients scored below normal on AS-20 than VFQ-25 composite scores (90% vs 29%; P < .0001; Table 2). On AS-20 subscales, 74% scored below normal on the psychosocial subscale and 75% scored below normal on the function subscale (Table 2). The VFQ-25 subscales with the highest proportion of subnormal scores were: driving (32%), distance activities (25%), and vision-specific role difficulties (21%; Table 2).

Patients With Diplopia

Of the 65 patients with diplopia, significantly more scored below normal on the AS-20

Discussion

Both AS-20 and VFQ-25 questionnaires detected reduced HRQOL in adults with strabismus. The patient-derived, strabismus-specific AS-20 questionnaire detected subnormal HRQOL more often than the vision-specific VFQ-25 questionnaire. The AS-20 questionnaire and component subscales (psychosocial and function) were better able to detect the impact of strabismus on HRQOL, in patients both with and without diplopia.

Our finding that more patients scored below normal thresholds using the AS-20 than

References (8)

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Cited by (59)

  • Diplopic versus nondiplopic strabismus: effects on functional vision and eye-related quality of life in adolescents

    2021, Journal of AAPOS
    Citation Excerpt :

    Although several previous studies document reduced quality of life in children and/or adolescents with strabismus,1-4 we are unaware of any evaluating whether strabismus with diplopia differs from strabismus without diplopia. Studies in adults with strabismus have shown greater deficits in function related quality of life domains with diplopia,6 and also that the presence of diplopia following strabismus surgery is associated with failure to improve quality of life.7 Data from the present study provide evidence of the additional impact of diplopia on quality of life in adolescents.

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