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      Comparison of psychosocial and emotional consequences of childhood strabismus on the families from rural and urban India

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          Abstract

          Purpose:

          To compare the psychosocial consequences of horizontal comitant strabismus in children between the families of urban and rural India.

          Materials and Methods:

          In this cohort study, an eight-question quality-of-life instrument was administered by trained staff to the guardians of strabismic children from rural and urban areas by a live interview.

          Results:

          This study included 93 strabismic-children aged 4-16 years of which 52 were females. Forty-one had esodeviation and 52 had exodeviation. Seventy per cent parents were extremely distressed due to squint, 65% were extremely distressed due to people's remarks, 65% were extremely worried, 55% children were extremely distressed due to people's remarks, 57% children were severely ostracized, 38% had severe difficulty in communication and 50% had difficulty to cope; 64% parents were not advised a corrective surgery. The difference between families from rural and urban areas, or whether a male child was affected or a female child or for an esodeviation or an exodeviation was statistically not significant. The questionnaire had a good internal consistency (Cronbach's Alpha = 0.71).

          Conclusions:

          There was a significant negative psychosocial and emotional impact of childhood strabismus that was not affected by the rural or urban location of the family or the gender of the strabismic child or type of the deviation. The quality-of-life instrument can be used as part of the clinical examination for strabismic children.

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          Most cited references39

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          Psychosocial aspects of strabismus study.

          To assess the psychosocial implications of growing up with and living with socially noticeable strabismus. Self-report mailed questionnaire and the Hopkins Symptom Checklist. Patients with strabismus who were seen at the University of California, Davis, Medical Center, Department of Ophthalmology, from 1976 to 1989. Forty-three female and male subjects aged 15 years or older who had a history of childhood strabismus that was uncorrected or incompletely corrected past the age of 13 years. None. Participants' responses to our survey and to the Hopkins Symptom Checklist. Strabismus had a negative impact on many aspects of our subjects' lives. They report difficulty with self-image, securing employment, interpersonal relationships, school, work, and sports. Furthermore, difficulties encountered did not go away after childhood, rather, the problems encountered by our subjects intensified in the teenage and adult years. Subjects demonstrated generalized higher levels of distress on the Hopkins Symptom Checklist than age- and sex-matched controls (P < .01). Psychosocial difficulties relating to socially noticeable strabismus are not just a problem for school-children but also for teenagers and adults. Correction of strabismus in the older teenager or adult may offer them improvement in psychosocial functioning, a benefit not previously reported in the literature.
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            The psychosocial benefits of corrective surgery for adults with strabismus.

            Few papers have addressed the psychological impact of strabismus in adults, with none comparing preoperative and postoperative data using standardised questionnaires relating surgical results and psychosocial outcomes. 46 participants were seen at their 6 week preoperative and 3 month postoperative appointments. Standardised measures of anxiety and depression (Hospital Anxiety and Depression Scale), social anxiety (Derriford Appearance Scale), and quality of life (WHOQoLBref) were completed. Preoperatively, levels of depression were comparable to relevant population norms; however, levels of general anxiety were slightly raised and levels of social anxiety and social avoidance were significantly poorer than population norms. Surgery resulted in significant improvements in psychosocial adjustment with improvements on all study variables for the participant group as a whole. The non-diplopic group made more significant gains than the diplopic group. Approximately one third of study measures were significantly correlated with the objective measure of eye misalignment preoperatively dropping to only one variable postoperatively. Calculations involving the subjective measure of eye misalignment and study variables showed the opposite pattern with five variables achieving significance postoperatively. There were no clear sex or age effects apparent in the data. Strabismus surgery offers significant improvements to psychological and physical functioning.
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              Study of the psychosocial aspects of strabismus.

              To systematically evaluate the perception of psychosocial difficulties due to strabismus and the impact of corrective surgery in adolescents and young adults in India. Patients 15 to 25 years of age with childhood onset ( or = 30 prism diopters of deviation for distance) were included in the study. After a detailed orthoptic evaluation, demographic data of the patients and their parents were recorded. Postgraduate Institute Health Questionnaire N-2 (standardized in India) was administered to rule out neuroticism in the patients. Psychosocial problems faced by the patients were evaluated with a semistructured interview schedule. Patients were evaluated 3 months after surgery using a similar interview schedule to assess the psychological impact of surgery. Eighty percent of both male and female patients had problems in their social life; 85% of the males and 75% of the females had personal problems due to squint. After surgery, a positive change in appearance was noticed by 97.5% and 95% noticed a change in self-esteem and self-confidence. These patients had difficulties with self-image and interpersonal relationships, faced ridicule at school and work, and generally avoided activities that brought attention to their defect. Substantial changes were noticed in them after corrective surgery, and the differences in their scores before and after surgery were statistically significant.
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                Author and article information

                Journal
                Indian J Ophthalmol
                IJO
                Indian Journal of Ophthalmology
                Medknow Publications (India )
                0301-4738
                1998-3689
                Jul-Aug 2009
                : 57
                : 4
                : 285-288
                Affiliations
                [1 ]Mahatme Eye Hospital and Eye Bank, 16, Central Excise Colony, Chhatrapati Square, Wardha Road, Nagpur, India
                [2 ]Jyotirmay Eye Clinic and Pediatric Low Vision Center, 205, Ganatra Estate, Pokhran Rd., No. 1, Khopat, Thane West – 400 601, India
                [3 ]Aditya Jyot Eye Hospital, 153, Maj. Parmeshwaran Rd., No. 9, Wadala, Mumbai - 400 031, Maharashtra, India
                Author notes
                Correspondence to Dr. Mihir Kothari, Jyotirmay Eye Clinic and Pediatric Low Vision Center, 205, Ganatra Estate, Pokhran Road No. 1, Khopat, Thane West - 400 601, Maharashtra, India. E-mail: drmihirkothari@ 123456jyotirmay.com
                Article
                IJO-57-285
                10.4103/0301-4738.53053
                2712697
                19574696
                75e12124-492f-4bb9-adf8-99f34822d2ae
                © Indian Journal of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 May 2008
                : 22 November 2008
                Categories
                Original Article

                Ophthalmology & Optometry
                quality of life,squint,children
                Ophthalmology & Optometry
                quality of life, squint, children

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