# The impact of surgical intervention on the psychosocial health and quality of life of children with strabismus

## TL;DR

This study shows that children with strabismus have worse psychosocial health and quality of life, and surgery improves these outcomes, but effects take time to appear.

## Contribution

The study demonstrates that strabismus surgery improves psychosocial health and quality of life with a delayed effect, typically visible 3 months post-surgery.

## Key findings

- Children with strabismus had lower quality of life and self-esteem, and higher social anxiety and perceived discrimination compared to those without strabismus.
- Surgery improved quality of life and self-esteem significantly 3 months post-surgery, with reduced social anxiety and perceived discrimination.
- The type and severity of strabismus correlate with psychosocial outcomes, with intermittent exotropia showing better quality of life than other types.

## Abstract

To compare the psychosocial health and quality of life of children with different types and prism diopters (Δ) of strabismus, and to observe the impact of surgery on the psychosocial health and quality of life of children with strabismus.

We use questionnaires to evaluate the scores of perceived discrimination (PD), social anxiety (SAD), self-esteem (S-E), and quality of life (QoL) of children. These indicators are compared between children with and without strabismus, as well as changes before and after strabismus surgery.

1. Children with strabismus had lower QoL and S-E scores than those without strabismus, while their SAD and PD scores were higher (p < 0.05). 2. Children with intermittent exotropia had higher QoL scores than the other types of strabismus (p < 0.05), vertical strabismus had higher SAD scores than the other three types (p < 0.05); 3. Patients with exotropia (-15Δ ≤ ∼ < -30Δ) had higher sores on QoL and S-E, had lower scores on SAD and individual PD than those with exotropia ( ≤ -30Δ) (p < 0.05). Patients with esotropia (+10Δ ≤ ∼ < +30Δ) had higher scores on QoL and S-E, had lower scores on group PD than those with esotropia ( ≥ +30Δ) (p < 0.05); 4. There were no significant differences in the scores of QoL and S-E between strabismus patients pre and 1 month post-surgery. These scores significantly increased 3 months after surgery (p = 0.000). There were no significant differences in some sub-dimensions of S-E between pre and post-surgery. There were no significant differences in SAD between pre and 1-mon-post-surgery, but it significantly decreased 3 months post-surgery compared to pre-surgery. There were some differences in PD between pre and post-surgery, although they didn’t reach the traditional statistical significance level (p = 0.056). Individual PD significantly decreased at 1 and 3 months after surgery (p = 0.010), and group PD significantly decreased at 3 months after surgery (p = 0.048).

Children with strabismus have lower psychosocial health and quality of life than those without strabismus. The type and severity of strabismus is correlated with mental health and quality of life. Surgery improved S-E and QoL for strabismus patients effectively and reduced PD and SAD. However, these changes exhibit a certain latency, typically occurring 3 months after surgery.