Browsing by Author "Chandler, Danielle L."

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    Health-related quality of life in children with untreated intermittent exotropia and their parents
    (Elsevier, 2021) Holmes, Jonathan M.; Hercinovic, Amra; Melia, B. Michele; Leske, David A.; Hatt, Sarah R.; Chandler, Danielle L.; Dean, Trevano W.; Kraker, Raymond T.; Enyedi, Laura B.; Wallace, David K.; Mohney, Brian G.; Cotter, Susan A.; Ophthalmology, School of Medicine
    Purpose To determine whether health-related quality of life (HRQOL) scores improved or worsened over 3 years of observation in childhood intermittent exotropia without treatment. Methods A total of 111 children aged 3-11 years with intermittent exotropia were assigned to observation in a previously reported randomized trial comparing patching with observation. The intermittent exotropia questionnaire (IXTQ) was administered at baseline, 6 months, and 36 months. Rasch-calibrated IXTQ domain scores (Child, Proxy, Parent-psychosocial, Parent-function, and Parent-surgery) were compared between time points. The Child IXTQ was administered only to children ≥5 years of age (n = 78). Results Overall, Child IXTQ and Proxy IXTQ scores showed no significant change over 36 months (mean improvement from baseline to 36 months of 3.2 points [95% CI, −1.9 to 8.2] and −2.4 points [95% CI: −7.9 to 3.1], resp.). By contrast, Parent-psychosocial, Parent-function, and Parent-surgery domain scores all improved over 36 months (mean improvements of 12.8 points [95% CI, 5.9-19.6] and 14.2 points [95% CI, 8.0-20.3] and 18.5 points [95% CI, 9.7-27.3], resp.). Conclusions HRQOL of children with intermittent exotropia remains stable with observation over 3 years (by both child and proxy report), whereas parental HRQOL improves.
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    Improvement in health-related quality of life following strabismus surgery for children with intermittent exotropia
    (Elsevier, 2021-04-24) Holmes, Jonathan M.; Hercinovic, Amra; Melia, B. Michele; Leske, David A.; Hatt, Sarah R.; Chandler, Danielle L.; Dean, Trevano W.; Kraker, Raymond T.; Enyedi, Laura B.; Wallace, David K.; Donahue, Sean P.; Cotter, Susan A.; Ophthalmology, School of Medicine
    Purpose: To investigate health-related quality of life (HRQOL) after strabismus surgery in children with intermittent exotropia (IXT) and relationships between HRQOL and surgical success. Methods: A total of 197 children with IXT aged 3-11 years (and 1 parent of each child) were enrolled in a previously reported randomized clinical trial comparing two surgical procedures. The Intermittent Exotropia Questionnaire (IXTQ) was administered before surgery (baseline), and again at 6 and 36 months following surgery. The child version of the IXTQ was only completed by children 5-11 years of age (n = 123). Outcomes were classified as “resolved” (exodeviation of <10Δ, no decreased stereoacuity, and no other nonsurgical treatment for IXT or reoperation), “suboptimal” (exotropia ≥10Δ by simultaneous prism and cover test or constant esotropia ≥6Δ or loss of ≥2 octaves of stereoacuity), or “intermediate.” Mean changes in Rasch-calibrated IXTQ domain scores (Child, Proxy, Parent-psychosocial, Parent-function, and Parent-surgery; converted to a 0-100 scale) were compared. Results: Overall, mean IXTQ domain scores improved for all domains from baseline to 36 months after surgery, ranging from 10.7 points (Child IXTQ; P < 0.0001) to 34.5 points (Parent-surgery IXTQ; P < 0.0001). At 36 months after surgery, 62 (39%) children had resolved IXT, whereas 38 (24%) had suboptimal outcome. Greater improvement was found in all mean domain scores with resolved IXT (range, 19.8-46.0 points) compared with suboptimal outcome (all comparisons P < 0.05). Conclusions: Successful surgery for childhood IXT results in measurable improvement in a child’s quality of life, in parental assessment of the child’s quality of life, and in quality of life for the parent.
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    The Relationship of Age and Other Baseline Factors to Outcome of Initial Surgery for Intermittent Exotropia
    (Elsevier, 2020-04) Repka, Michael X.; Chandler, Danielle L.; Holmes, Jonathan M.; Donahue, Sean P.; Hoover, Darren L.; Mohney, Brian G.; Phillips, Paul H.; Stout, Ann U.; Ticho, Benjamin H.; Wallace, David K.; Ophthalmology, School of Medicine
    Purpose: To determine whether age at surgery is associated with surgical outcome of intermittent exotropia (IXT) at 3 years. Design: Secondary analysis of pooled data from a randomized trial. Methods: A total of 197 children 3 to <11 years of age with basic-type IXT of 15-40 prism diopters (Δ) were randomly assigned to 1 of 2 surgical procedures for treatment of intermittent exotropia. Masked examinations were conducted every 6 months for 3 years. The primary outcome was suboptimal surgical outcome by 3 years, defined as constant or intermittent exotropia of ≥10 Δ at distance or near by simultaneous prism and cover test (SPCT); constant esotropia of ≥6 Δ at distance or near by SPCT; or decrease in near stereoacuity of ≥2 octaves, at any masked examination; or reoperation without meeting any of these criteria. Results: The cumulative probability of a suboptimal surgical outcome by 3 years was 28% (19 of 72) for children 3 to <5 years of age, compared with 50% (57 of 125) for children 5 to <11 years of age (adjusted hazard ratio = 2.05; 95% confidence interval = 1.16 to 3.60). No statistically significant associations were found between suboptimal outcome and other baseline factors (magnitude of deviation, control score, fixation preference, or near stereoacuity) (P values ≥ .20). Conclusions: This analysis suggests that in children with IXT, younger age at surgery (3 to <5 years) is associated with better surgical outcomes; however, further evidence from a randomized trial comparing immediate with delayed surgery is needed for confirmation.