To assess the general health-related quality of life (QOL) in children with intermittent exotropia (IXT) before and 3 months after surgery, by interviewing individual patients and their parents.
Prospective, interventional case series.
Twenty-one patients undergoing IXT surgery and their parents were included. Using the Pediatric Quality of Life Inventory (PedsQL), children and parents were separately questioned about QOL of patients.
The mean patients’ age was 8.6 ± 3.2 years (SD), with range of 5–16 years. The children responded that all PedsQL scores were significantly improved by surgery, and the highest improvement was observed in the school subscale score. When the parents rated the children’s QOL, significant improvements were limited to 3 out of 7 subscales, including the emotional, psychosocial health summary, and total scores. The improvements in the PedsQL score were not correlated with age, size of deviation changes following surgery, nor the improvement in binocular vision.
The general health-related QOL significantly improved by surgery in pediatric patients with IXT, while the improvement was considerably underestimated by the parents. The children reported the greatest improvement in the school functioning subscale, whereas parents failed to discern this improvement. The discrepancy in children’ and parents’ views can be an important factor when considering indication of corrective surgery and evaluating surgical outcomes.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Lin S, Congdon N, Yam JC, Huang Y, Qiu K, Ma D, et al. Alcohol use and positive screening results for depression and anxiety are highly prevalent among Chinese children with strabismus. Am J Ophthalmol. 2014;157:894–900.
Wen G, McKean-Cowdin R, Varma R, Tarczy-Hornoch K, Cotter SA, Borchert M, et al. General health-related quality of life in preschool children with strabismus or amblyopia. Ophthalmology. 2011;118:574–80.
Yamada T, Hatt SR, Leske DA, Holmes JM. Specific health-related quality of life concerns in children with intermittent exotropia. Strabismus. 2012;20:145–51.
Hatt SR, Leske DA, Liebermann L, Holmes JM. Symptoms in children with intermittent exotropia and their impact on health-related quality of life. Strabismus. 2016;24:139–45.
Tu C, Ye L, Jiang L, Wang Y, Li Y. Impact of strabismus on the quality of life of Chinese Han teenagers. Patient Prefer Adherence. 2016;10:1021–4.
Sah SP, Sharma IP, Chaudhry M, Saikia M. Health-related quality of life (HRQoL) in young adults with strabismus in India. J Clin Diagn Res. 2017;11:NC01–4.
Schuster AK, Elflein HM, Pokora R, Schlaud M, Baumgarten F, Urschitz MS. Health-related quality of life and mental health in children and adolescents with strabismus - results of the representative population-based survey KiGGS. Health Qual Life Outcomes. 2019;17:81.
Hatt SR, Leske DA, Adams WE, Kirgis PA, Bradley EA, Holmes JM. Quality of life in intermittent exotropia: child and parent concerns. Arch Ophthalmol. 2008;126:1525–9.
Hatt SR, Leske DA, Liebermann L, Mohney BG, Brodsky MC, Yamada T, et al. Associations between health-related quality of life and the decision to perform surgery for childhood intermittent exotropia. Ophthalmology. 2014;121:883–8.
Dickmann A, Aliberti S, Rebecchi MT, Aprile I, Salerni A, Petroni S, et al. Improved sensory status and quality-of-life measures in adult patients after strabismus surgery. J AAPOS. 2013;17:25–8.
Xu M, Yu H, Chen Y, Xu J, Zheng J, Yu X. Long-term quality of life in adult patients with strabismus after corrective surgery compared to the general population. PLoS ONE. 2016;11:e0166418.
Fujiike K, Mizuno Y, Hiratsuka Y, Yamada M, Surgery Study Group. Quality of life and cost-utility assessment after strabismus surgery in adults. Jpn J Ophthalmol. 2011;55:268–76.
Archer SM, Musch DC, Wren PA, Guire KE, Del Monte MA. Social and emotional impact of strabismus surgery on quality of life in children. J AAPOS. 2005;9:148–51.
Ziaei H, Katibeh M, Mohammadi S, Mirzaei M, Moein HR, Kheiri B, et al. The impact of congenital strabismus surgery on quality of life in children. J Ophthalmic Vis Res. 2016;11:188–92.
Wang X, Gao X, Xiao M, Tang L, Wei X, Zeng J, Li Y. Effectiveness of strabismus surgery on the health-related quality of life assessment of children with intermittent exotropia and their parents: a randomized clinical trial. J AAPOS. 2015;19:298–303.
Varni JW, Seid M, Kurtin PS. PedsQL 4.0: Reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39:800–12.
Kobayashi K, Kamibeppu K. Measuring quality of life in Japanese children: development of the Japanese version of PedsQLTM. Pediatr Int. 2010;52:80–8.
Grindler DJ, Blank SJ, Schulz KA, Witsell DL, Lieu JE. Impact of otitis media severity on children’s quality of life. Otolaryngol Head Neck Surg. 2014;151:333–40.
El Shafei AM, Soliman Hegazy I, Fadel FI, Nagy EM. Assessment of quality of life among children with end-stage renal disease: a cross-sectional study. J Environ Public Health. 2018;2018:8565498.
Buck D, Clarke MP, Powell C, Tiffin P, Drewett RF. Use of the PedsQL in childhood intermittent exotropia: estimates of feasibility, internal consistency reliability and parent-child agreement. Qual Life Res. 2012;21:727–36.
Jozefiak T, Larsson B, Wichstrøm L, Mattejat F, Ravens-Sieberer U. Quality of Life as reported by school children and their parents: a cross-sectional survey. Health Qual Life Outcomes. 2008;6:34.
Cremeens J, Eiser C, Blades M. Factors influencing agreement between child self-report and parent proxy-reports on the Pediatric Quality of Life Inventory 4.0 (PedsQL) generic core scales. Health Qual Life Outcomes. 2006;4:58.
Schepers SA, van Oers HA, Maurice-Stam H, Huisman J, Verhaak CM, Grootenhuis MA, et al. Health related quality of life in Dutch infants, toddlers, and young children. Health Qual Life Outcomes. 2017;15:81.
Ferreira PL, Baltazar CF, Cavalheiro L, Cabri J, Gonçalves RS. Reliability and validity of PedsQL for Portuguese children aged 5–7 and 8–12 years. Health Qual Life Outcomes. 2014;12:122.
Conflicts of interest
Y. Morita, None; T. Hiraoka, None; T. Oshika, None.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Corresponding Author: Tetsuro Oshika
About this article
Cite this article
Morita, Y., Hiraoka, T. & Oshika, T. Influence of intermittent exotropia surgery on general health-related quality of life: different perception by children and parents. Jpn J Ophthalmol 65, 326–330 (2021). https://doi.org/10.1007/s10384-020-00811-7
- Intermittent exotropia
- Pediatric patients
- Quality of life