Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
Retina Foundation of the Southwest, Dallas, Texas.
JAMA Ophthalmol. 2020 May 1;138(5):528-535. doi: 10.1001/jamaophthalmol.2020.0539.
Strabismus is common, affecting 2% to 4% of children, but how children and their families are affected in everyday life is poorly understood.
To evaluate the association of strabismus with functional vision and eye-related quality of life in children and their families using the Pediatric Eye Questionnaire (PedEyeQ).
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted between December 2017 and October 2019 and included 91 children with strabismus and 166 visually normal controls across 3 age groups (0-4, 5-11, and 12-17 years) who were enrolled at Mayo Clinic, Rochester, Minnesota, and Retina Foundation of the Southwest, Dallas, Texas.
Children completed the child PedEyeQ (5 to 11- and 12 to 17-year versions: functional vision, bothered by eyes/vision, social, and frustration/worry domains); parents completed the proxy (0 to 4-, 5 to 11-, and 12 to 17-year versions: functional vision, bothered by eyes/vision, social, frustration/worry, and eye care domains) and the parent PedEyeQ (impact on parent and family, worry about child's eye condition, worry about child's self-perception and interactions, and worry about child's functional vision domains). Rasch-calibrated PedEyeQ scores were calculated for each domain and converted to 0 (worst) to 100.
PedEyeQ domain scores.
Of 91 participants with strabismus, 41 (45.1%) were girls, 74 (81.3%) were white, 4 (4.4%) were Asian, 5 (5.5%) were more than 1 race, 5 (5.5%) were African American, and 2 (2.2%) were American Indian/Alaska Native. Child PedEyeQ domain scores were lower with strabismus vs visually normal controls among children ages 5 to 11 years and the greatest mean (SD) difference was in functional vision (12 [14] points; 95% CI, 6-18; P = .001), and among children ages 12 to 17 years, the greatest mean (SD) difference was in frustration/worry (27 [13] points; 95% CI, 18-36; P < .001). Proxy PedEyeQ domain scores were also lower with strabismus. The greatest difference among children ages 0 to 4 years was in functional vision (13 [9] points; 95% CI, 9-16; P < .001), among children ages 5 to 11 years was in functional vision (26 [10] points; 95% CI, 22-30; P < .001); and among children ages 12 to 17 years was in functional vision (21 [12] points; 95% CI, 12-30; P < .001), social (21 [13] points; 95% CI, 12-30; P < .001), and frustration/worry (21 [13] points; 95% CI, 12-30; P < .001). Parent PedEyeQ domain scores were lower with strabismus; the greatest difference was in worry about child's eye condition (38 [14] points; 95% CI, 34-42; P < .001).
Strabismus is associated with reduced functional vision and eye-related quality of life in children. Parents of children with strabismus also experience a reduced quality of life. These findings advance our understanding of how strabismus affects children and their families and should be considered when defining patient management goals.
重要性：斜视很常见，影响 2%至 4%的儿童，但儿童及其家庭在日常生活中受到的影响尚不清楚。
目的：使用小儿眼科问卷（PedEyeQ）评估斜视与儿童的功能性视力和眼相关生活质量之间的关联。
设计、地点和参与者：这是一项横断面研究，于 2017 年 12 月至 2019 年 10 月进行，在明尼苏达州罗切斯特市的 Mayo 诊所和德克萨斯州达拉斯市的视网膜基金会西南部纳入了 91 名斜视儿童和 166 名视力正常的对照组，年龄在 0-4 岁、5-11 岁和 12-17 岁之间。
暴露：儿童完成儿童版 PedEyeQ（5 至 11 岁和 12 至 17 岁版本：功能性视力、眼睛/视力困扰、社交和挫折/忧虑领域）；父母完成代理版（0 至 4 岁、5 至 11 岁和 12 至 17 岁版本：功能性视力、眼睛/视力困扰、社交、挫折/忧虑和眼科保健领域）和父母版 PedEyeQ（对父母和家庭的影响、对孩子眼睛状况的担忧、对孩子自我认知和互动的担忧、对孩子功能性视力的担忧）。为每个领域计算了经过拉什校准的 PedEyeQ 分数，并转换为 0（最差）至 100。
主要结果和措施：PedEyeQ 领域得分。
结果：在 91 名斜视儿童中，41 名（45.1%）为女孩，74 名（81.3%）为白人，4 名（4.4%）为亚洲人，5 名（5.5%）为多种族，5 名（5.5%）为非裔美国人，2 名（2.2%）为美洲印第安人/阿拉斯加原住民。与视力正常的对照组相比，5 至 11 岁儿童斜视组的儿童 PedEyeQ 领域得分较低，最大平均（SD）差异为功能性视力（12 [14] 分；95%CI，6-18；P =.001），12 至 17 岁儿童最大平均（SD）差异为挫折/忧虑（27 [13] 分；95%CI，18-36；P <.001）。代理版 PedEyeQ 领域得分也较低。0 至 4 岁儿童最大差异为功能性视力（13 [9] 分；95%CI，9-16；P <.001），5 至 11 岁儿童为功能性视力（26 [10] 分；95%CI，22-30；P <.001），12 至 17 岁儿童为功能性视力（21 [12] 分；95%CI，12-30；P <.001）、社交（21 [13] 分；95%CI，12-30；P <.001）和挫折/忧虑（21 [13] 分；95%CI，12-30；P <.001）。斜视儿童的父母版 PedEyeQ 领域得分较低；最大差异是对孩子眼睛状况的担忧（38 [14] 分；95%CI，34-42；P <.001）。
结论和相关性：斜视与儿童功能性视力和眼相关生活质量下降有关。斜视儿童的父母生活质量也有所下降。这些发现提高了我们对斜视如何影响儿童及其家庭的理解，在确定患者管理目标时应考虑这些发现。
