Quality of life remains stable for children with intermittent exotropia
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The health-related quality of life in children with intermittent exotropia remained stable over 3 years, while their parents’ improved, according to study result published in the Journal of the American Association for Pediatric Ophthalmology and Strabismus.
Jonathan M. Holmes, BM, BCh, and colleagues used observations from a previously reported randomized controlled trial of children with untreated intermittent exotropia to determine health-related quality of life (HRQOL). In the original study, the Intermittent Exotropia Questionnaire (IXTQ) was used to evaluate child, proxy (parent perception of effects on child) and parent HRQOL at enrollment, 6 months and 36 months. The parent IXTQ examined the concerns of parents regarding surgery (parent-surgery), child social interactions (parent-psychosocial) and their child’s eye function (parent-function).
The current study used IXTQ results from children aged 5 to 11 years (old enough to answer questionnaire) and from parents of children aged 3 to 11 years.
HRQOL did not significantly change for child and proxy from enrollment to 6 months or from enrollment to 36 months. However, there was improvement during those time frames for parent-function (8.8 points [95% CI, 3.6-14.0] and 14.2 points [95% CI, 8.0-20.3]) and parent-psychosocial HRQOL (8.2 points [95% CI, 1.5-14.9] and 12.8 points [95% CI, 5.9-19.6]). Parent-surgery HRQOL improved between baseline and 36 months (18.5 points [95% CI, 9.7-27.3]).
Holmes and colleagues theorized child and proxy score stability and improved parent scores may be connected “to the low frequency of clinical deterioration of intermittent exotropia in these children who were observed over this 36-month period” or less parental anxiety about the condition, they wrote.
Limitations of the study were inclusion of less severe intermittent exotropia due to concurrent surgical research by the same researchers, incomplete follow-up (80% at 3 years) and no comparison of IXTQ scores made to scores of patients randomized to patching in the original trial.
Perspective
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Intermittent exotropia is one of the most common types of strabismus in early childhood. Parents will often ask if any active treatment is recommended for their child’s condition. Holmes and colleagues offered justification for observation as a valid management option for certain types of intermittent exotropia in children.
The study results indicate that most children and parents did not experience any negative quality of life changes related to their exotropia over a period of 3 years of observation. It should be noted that this study does not survey patient symptoms, but instead it focuses on the psychosocial impacts of intermittent exotropia on children and parents. Nonetheless, the study results may reassure optometrists and parents that observation may not significantly affect their child’s quality of life.
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