Successful Surgery Improves Quality of Life in Adults With Strabismus

Deborah Brauser

April 19, 2010

April 19, 2010 (Orlando, Florida) — Both the new Adult Strabismus Questionnaire (AS-20), developed at the Mayo Clinic, and the traditional Visual Function Questionnaire (VFQ-25), from the National Eye Institute (NEI), show substantial improvements in health-related quality of life (HRQOL) for adult patients who undergo successful strabismus surgery, according to a new study.

In addition, the results showed postsurgery HRQOL improvements in adults both with and without diplopia.

These findings were presented here at the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 36th Annual Meeting in a poster named one of the event's "Best of Show" by the AAPOS.

"The responsiveness of the AS-20 and VFQ-25 to successful strabismus surgery has not been previously reported," said David Leske, MS, from the Department of Ophthalmology at the Mayo Clinic in Rochester, Minnesota, during his presentation of the results.

David Leske

"Of course each patient is different, and they're all going to have different outcomes, but in our cohort, we've shown that strabismus surgery actually does improve quality of life," added Mr. Leske.

Significant Improvements

A total of 106 adults with strabismus between the ages of 18 and 84 years (mean age, 48.5 years; 57% female; 75% with diplopia) were enrolled in this study and given the AS-20 and VFQ-25 to complete before and after undergoing strabismus surgery.

Results showed that the surgery was a success, based on postoperative diplopia and angle, in 65 (61%) of the patients, whereas 32 were deemed partial successes and 9 were deemed surgical failures.

In the 80 total patients with preoperative diplopia, 46 (58%) had successful surgical procedures, 27 had partial success, and 7 had failures. For these patients, the AS-20 and VFQ-25 scores improved significantly after successful surgery (P < .0001 for both), as well as after partial success.

"There were improvements even in those who were not ideally aligned," reported Mr. Leske. "Improving angle, even if not considered significant, did help many of these patients."

In the 26 nondiplopic patients, 19 (73%) had successful surgical procedures, 5 had partial success, and 2 had failures. The VFQ-25 scores improved (P = .005) and the AS-20 scores improved significantly (P < .0001) after surgical success. The scores on both measuring tools did not significantly improve for those with partial success.

"Basically, both the AS-20 and the VFQ-25 were responsive to changes in ocular alignment in adults undergoing successful strabismus surgery, with the AS-20 showing greater responsiveness in nondiplopic patients than the VFQ-25," said Mr. Leske. "That's to be expected since the AS-20 is a strabismus-specific questionnaire."

In addition, HRQOL improvements, shown by changes in AS-20 scores, were significantly greater in the surgical success group compared with the nonsuccess group for both diplopic patients (21.3 vs 8.8, P = .002) and those without diplopia (23.8 vs -3.1, P = .05).

The investigators also examined score changes on the 2 subscales of the AS-20: psychosocial and function. "For diplopic patients, you would suspect that their function would be more affected after successful surgery, and that's indeed what we found [27.5 for function change vs 10.0 for psychosocial change]," explained Mr. Leske.

"In the nondiplopic patients, we saw that there was actually a larger degree of change in the psychosocial aspect than in function [27.5 vs 7.5, respectively]", he added.

"This study showed that yes, we can improve patients' quality of life and it's not just all cosmetic, and we showed that you can actually put a number on the improvement," summarized Mr. Leske. "I think the main thing is that we've got good tools now to do additional research on strabismus and to find different interventions."

Compelling Evidence

"This is a very well-done study and shows that, overall, patients who have strabismus surgery have a better quality of life as tested by this new tool," said poster session moderator Stephen Christiansen, MD, pediatric ophthalmologist and chair of the Department of Ophthalmology at Boston University in Massachusetts and member of the AAPOS Program Committee. He was not involved in this study.

"Particularly amongst adults, there remains a concern that a patient's insurance will not cover the cost of strabismus surgery," noted Dr. Christiansen. "For a long time, many third-party payers have considered strabismus in adults as a cosmetic concern with little functional significance and that, for the most part, these patients were doing fine without surgery."

He added, "The reason that this is an important study is that it begins to look carefully at how patients do socially, economically, etc, when their strabismus is corrected. [It] showed that for most, the quality of life is much better, which correlates with what we see when we operate on adults [in our practice]. They are thrilled to have their eyes straight."

"Overall, this [study] proves a point that all of us suspected in the first place," concluded Dr. Christiansen. "And I think [the results] should be quite compelling because patient satisfaction with healthcare and patient well-being is really what we had hoped for when we chose pediatric ophthalmology and strabismus as a career."

This study was supported by the NEI, Research to Prevent Blindness, and the Mayo Foundation. Mr. Leske and Dr. Christiansen have disclosed no relevant financial relationships.

The new AS-20 is available to anyone for free download at

American Association for Pediatric Ophthalmology (AAPOS) 36th Annual Meeting: Abstract 82/Poster 3. Presented April 15, 2010.


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