What Makes a Good Operation Great?: The Role of HRQOL in Evaluating Success of Strabismus Surgery
Saurabh Jain; Peng Yong Sim; Charles Cleland; Jonathan Dominic
Royal Free Hospital
Introduction: Evaluation of strabismus surgery outcomes based on health-related quality of life (HRQOL) criteria is important from the patient’s perspective. The main aim of this study was to explore pre- and postoperative factors that influence the success of adult strabismus surgery based on HRQOL criteria.
Methods: HRQOL criteria of strabismus surgery was assessed using the Adult Strabismus 20 (AS-20) questionnaire. Adult patients (≥16 y/o) undergoing strabismus surgery between 2014-2016 were identified using a treatment register. Pre- and postoperative AS-20 score were calculated. HRQOL surgical success was defined as a pre- to postoperative change in AS-20 score exceeding previously reported 95% limits of agreement. Any relationship between: demographic factors (gender and age); presence or absence of diplopia; type and magnitude of deviation; change in total deviation; and preoperative AS20 score with HRQOL success was investigated.
Results: Eighty-seven patients (mean age 47 years; 53% female) were included in the study. The median preoperative AS-20 score was 58.8. Postoperatively, the median AS-20 score was significantly higher at 72.5 (Z=-6.536, p<0.0001). 54 of 87 (62%) of surgeries were classified as success. Lower preoperative AS-20 score was associated with a higher rate of HRQOL success (p=0.001). None of the other factors considered were significantly related to the rate of HRQOL success.
Discussion: Lower preoperative AS-20 score is strongly and independently related to HRQOL success in strabimus surgery.
Conclusion: This suggests that patients who are more concerned about the psychosocial or functional aspect of their strabismus seem to gain the most benefit from strabismus surgery.
References:  Leske DA, Hatt SR, Holmes JM. Test-Retest Reliability of Health-Related Quality-of-Life Questionnaires in Adults with Strabismus. Am J Ophthalmol 2010;149:672-6.