Factors associated with failure of adult strabismus-20 questionnaire scores to improve following strabismus surgery

Sarah R. Hatt, David A. Leske, Kemuel L. Philbrick, Jonathan M Holmes

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

IMPORTANCE Health-related quality of life (HRQOL) typically improves following strabismus surgery. Nevertheless, for some patients, HRQOL does not improve, and reasons for this are unknown. OBJECTIVE To identify factors associated with failure of adult strabismus-20 (AS-20) HRQOL scores to improve following strabismus surgery. DESIGN, SETTING, AND PARTICIPANTS Prospective observational case series at the Mayo Clinic, Rochester, Minnesota, comprising 276 adults, between July 2012 and August 2016. MAIN OUTCOMES AND MEASURES Participants completed the AS-20 HRQOL questionnaire, diplopia questionnaire, Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) (depressive symptoms), and Type-D Scale 14 questionnaire (type-Distressed [type-D] personality) both preoperatively and 6 weeks postoperatively. To assess factors associated with failure of HRQOL to improve (no change or decrease in score), univariate and multiple logistic regression analyses were performed. Each of the 4 AS-20 domains (self-perception, interactions, reading function, and general function) were analyzed separately including only patients able to improve at least by the magnitude of previously defined 95%limits of agreement. Factors assessed were age (at onset and at surgery), sex, number of previous surgeries, presence of visually obtrusive facial anomaly, visual acuity, preoperative and postoperative diplopia questionnaire scores, alignment (as a vector), presence of esotropia, presence of a vertical deviation, CESD-R scores, and type-D personality. Stepwise multiple logistic regression analyses were performed to assess factors associated with failure of AS-20 scores to improve for each domain. RESULTS Of the 276 participants, the median age was 57 years (range, 18-91 years), 153 were women (55%), and 266 were white (96%). Failure to improve was associated with worse diplopia postoperatively on the self-perception (adjusted risk ratio [RR], 1.01; 95%CI, 1.00-1.02), reading function (adjusted RR, 1.02; 95%CI, 1.01-1.03), and general function domains (adjusted RR, 1.02; 95%CI, 1.01-1.03). In addition, failure to improve on the self-perception domain was associated with type-D personality postoperatively (adjusted RR, 4.26; 95%CI, 1.90-9.57) and failure to improve on the interactions domain was associated with postoperative depressive symptoms (adjusted RR, 1.04; 95%CI, 1.02-1.06) and coexisting visually obtrusive anomaly (adjusted RR, 2.12; 95%CI, 1.04-4.32). CONCLUSIONS AND RELEVANCE Postoperative diplopia, depressive symptoms, type-D personality, and visually obtrusive facial anomalies were associated with failure of AS-20 scores to improve (remaining the same or worsening) following strabismus surgery. The association of nonstrabismus factors may have implications for patient treatment and is worthy of continued study.

Original languageEnglish (US)
Pages (from-to)46-52
Number of pages7
JournalJAMA Ophthalmology
Volume136
Issue number1
DOIs
StatePublished - Jan 1 2018

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Strabismus
Type D Personality
Diplopia
Odds Ratio
Quality of Life
Depression
Self Concept
Reading
Epidemiologic Studies
Logistic Models
Regression Analysis
Esotropia
Surveys and Questionnaires
Age of Onset
Visual Acuity
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Ophthalmology

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Factors associated with failure of adult strabismus-20 questionnaire scores to improve following strabismus surgery. / Hatt, Sarah R.; Leske, David A.; Philbrick, Kemuel L.; Holmes, Jonathan M.

In: JAMA Ophthalmology, Vol. 136, No. 1, 01.01.2018, p. 46-52.

Research output: Contribution to journalArticle

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N2 - IMPORTANCE Health-related quality of life (HRQOL) typically improves following strabismus surgery. Nevertheless, for some patients, HRQOL does not improve, and reasons for this are unknown. OBJECTIVE To identify factors associated with failure of adult strabismus-20 (AS-20) HRQOL scores to improve following strabismus surgery. DESIGN, SETTING, AND PARTICIPANTS Prospective observational case series at the Mayo Clinic, Rochester, Minnesota, comprising 276 adults, between July 2012 and August 2016. MAIN OUTCOMES AND MEASURES Participants completed the AS-20 HRQOL questionnaire, diplopia questionnaire, Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) (depressive symptoms), and Type-D Scale 14 questionnaire (type-Distressed [type-D] personality) both preoperatively and 6 weeks postoperatively. To assess factors associated with failure of HRQOL to improve (no change or decrease in score), univariate and multiple logistic regression analyses were performed. Each of the 4 AS-20 domains (self-perception, interactions, reading function, and general function) were analyzed separately including only patients able to improve at least by the magnitude of previously defined 95%limits of agreement. Factors assessed were age (at onset and at surgery), sex, number of previous surgeries, presence of visually obtrusive facial anomaly, visual acuity, preoperative and postoperative diplopia questionnaire scores, alignment (as a vector), presence of esotropia, presence of a vertical deviation, CESD-R scores, and type-D personality. Stepwise multiple logistic regression analyses were performed to assess factors associated with failure of AS-20 scores to improve for each domain. RESULTS Of the 276 participants, the median age was 57 years (range, 18-91 years), 153 were women (55%), and 266 were white (96%). Failure to improve was associated with worse diplopia postoperatively on the self-perception (adjusted risk ratio [RR], 1.01; 95%CI, 1.00-1.02), reading function (adjusted RR, 1.02; 95%CI, 1.01-1.03), and general function domains (adjusted RR, 1.02; 95%CI, 1.01-1.03). In addition, failure to improve on the self-perception domain was associated with type-D personality postoperatively (adjusted RR, 4.26; 95%CI, 1.90-9.57) and failure to improve on the interactions domain was associated with postoperative depressive symptoms (adjusted RR, 1.04; 95%CI, 1.02-1.06) and coexisting visually obtrusive anomaly (adjusted RR, 2.12; 95%CI, 1.04-4.32). CONCLUSIONS AND RELEVANCE Postoperative diplopia, depressive symptoms, type-D personality, and visually obtrusive facial anomalies were associated with failure of AS-20 scores to improve (remaining the same or worsening) following strabismus surgery. The association of nonstrabismus factors may have implications for patient treatment and is worthy of continued study.

AB - IMPORTANCE Health-related quality of life (HRQOL) typically improves following strabismus surgery. Nevertheless, for some patients, HRQOL does not improve, and reasons for this are unknown. OBJECTIVE To identify factors associated with failure of adult strabismus-20 (AS-20) HRQOL scores to improve following strabismus surgery. DESIGN, SETTING, AND PARTICIPANTS Prospective observational case series at the Mayo Clinic, Rochester, Minnesota, comprising 276 adults, between July 2012 and August 2016. MAIN OUTCOMES AND MEASURES Participants completed the AS-20 HRQOL questionnaire, diplopia questionnaire, Center for Epidemiologic Studies Depression Scale-Revised (CESD-R) (depressive symptoms), and Type-D Scale 14 questionnaire (type-Distressed [type-D] personality) both preoperatively and 6 weeks postoperatively. To assess factors associated with failure of HRQOL to improve (no change or decrease in score), univariate and multiple logistic regression analyses were performed. Each of the 4 AS-20 domains (self-perception, interactions, reading function, and general function) were analyzed separately including only patients able to improve at least by the magnitude of previously defined 95%limits of agreement. Factors assessed were age (at onset and at surgery), sex, number of previous surgeries, presence of visually obtrusive facial anomaly, visual acuity, preoperative and postoperative diplopia questionnaire scores, alignment (as a vector), presence of esotropia, presence of a vertical deviation, CESD-R scores, and type-D personality. Stepwise multiple logistic regression analyses were performed to assess factors associated with failure of AS-20 scores to improve for each domain. RESULTS Of the 276 participants, the median age was 57 years (range, 18-91 years), 153 were women (55%), and 266 were white (96%). Failure to improve was associated with worse diplopia postoperatively on the self-perception (adjusted risk ratio [RR], 1.01; 95%CI, 1.00-1.02), reading function (adjusted RR, 1.02; 95%CI, 1.01-1.03), and general function domains (adjusted RR, 1.02; 95%CI, 1.01-1.03). In addition, failure to improve on the self-perception domain was associated with type-D personality postoperatively (adjusted RR, 4.26; 95%CI, 1.90-9.57) and failure to improve on the interactions domain was associated with postoperative depressive symptoms (adjusted RR, 1.04; 95%CI, 1.02-1.06) and coexisting visually obtrusive anomaly (adjusted RR, 2.12; 95%CI, 1.04-4.32). CONCLUSIONS AND RELEVANCE Postoperative diplopia, depressive symptoms, type-D personality, and visually obtrusive facial anomalies were associated with failure of AS-20 scores to improve (remaining the same or worsening) following strabismus surgery. The association of nonstrabismus factors may have implications for patient treatment and is worthy of continued study.

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