Allergic conjunctivitis negatively impacts quality of life for children, parents
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Quality of life for children with allergic conjunctivitis was significantly lower for them and their parents compared with children without it, according to findings published in JAMA Ophthalmology.
“Although the quality of life (QOL) of patients with allergic conjunctivitis (AC) has been reported, to our knowledge, none of these studies focused on children, which is the patient population most affected by AC. In addition, these studies did not discuss whether there were any associations between AC and these patients’ parents,” Shi-yao Zhang, MD, and colleagues from Sun Yat-sen University, in Guangzhou, China, wrote.
In a prospective case-control study, Zhang and colleagues analyzed data from 92 youths aged 5 to 18 years with AC (83.7% boys) and their parents (72.8% women), in addition to 96 healthy age-matched children (57.3% girls) and their parents (79.2% women) who served as controls. The researchers observed participants at Zhongshan Ophthalmic Center from Nov. 16, 2019, through Jan. 20, 2020.
The investigators subdivided 92 participants in the AC group into cohorts with vernal keratoconjunctivitis (VKC; n = 23 [25%]) or atopic keratoconjunctivitis (AKC; n = 7 [7.6%]) and seasonal allergic conjunctivitis (SAC; n = 26 [28.3%]) or perennial allergic conjunctivitis (PAC; n = 36 [39.1%]).
Researchers used the Pediatric Quality of Life Inventory, version 4.0 (PedsQL) to evaluate scores for the children and their parents. Scores are scaled from 0 to 100, valuing the highest number as the best quality of life with the least negative aspects.
Median total PedsQL scores were lower in both children with AC (69.6 [interquartile range [IQR] = 66.3-72.8 vs. 96.7; IQR = 92.7-98.9; P < .001) and their parents (68.8; IQR = 63.9-71.4 vs. 96.5; IQR = 95.1-97.9; P < .001). However, the reduction in health-related QOL was more significant in children with VKC/AKC compared with those with SAC/PAC (difference, –3.3; 95% CI, –5.4 to –1.1) and their parents (difference, –4.3; 95% CI, –7.1 to –2.1).
Additionally, a higher corneal fluorescein staining score was associated with lower QOL in children with AC (Beta, –1.16; 95% CI, –1.8 to –0.52); higher corneal fluorescein staining scores (Beta, –1.12; 95% CI, –1.74 to –0.5) and several clinical consultations (Beta, –3.96; 95% CI, –7.34 to –0.57) correlated with reduced QOL in parents.
The parents' QOL scores were associated with their children's QOL scores (correlation coefficient, r = 0.59; P < .001).
Limitations of the study include the socioeconomic status and condition severity of each participant. Also, because an AC-specific QOL questionnaire was unavailable, participants used a questionnaire specific to allergic rhinitis and asthma instead.
“An unexpected finding was that the decrease of QOL in children with AC was worse than in previous studies of children diagnosed with blinding diseases, such as glaucoma and congenital cataract, in which the same PedsQL questionnaires had been used,” Zhang and colleagues wrote. “The findings of this study suggest a multifaceted association of allergic conjunctivitis with quality of life; detailed assessment of quality of life for improved care of pediatric patients with chronic allergic conjunctivitis would be useful.”
Perspective
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Debora Lee Chen, OD, MPH, FAAO
Admittedly, when it comes to AC, a patient’s QOL has not been a primary concern. However, Zhang and colleagues argue that QOL should be more heavily considered when a pediatric patient presents with AC.
In their prospective case-controlled study, they found that QOL was significantly lower in patients with AC. Not surprisingly, the more corneal complications there were, the lower the QOL.
While I agreed with their conclusion, I found some of their discussion points curious. Could AC really be linked to poorer academics (school performance had the lowest QOL score)? Why was QOL lower in patients with AC than in those with glaucoma or congenital cataract? Their suggestion gives me pause: "cultural differences, continuous eye discomfort and the recurrent nature of AC."
The authors admit that their sample may have incurred selection bias, as, being at a tertiary care center, their patients may present with more severe disease. In addition, they note that their questionnaire was nonspecific for AC. Could conditions like allergic rhinitis or asthma have confounded their findings? These study limitations do not compel me to weigh QOL more than I currently do when treating patients with AC.
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