Translation and validation of a questionnaire on the impact of strabismus on the quality of life of patients / Tradução e validação de um questionário sobre impacto na qualidade de vida em pacientes com estrabismo

ABSTRACT Objective: To translate and validate the Adult Strabismus Quality of Life Questionnaire into Brazilian Portuguese. Methods: A cross-sectional study for linguistic and cross-cultural validation of the Adult Strabismus Quality of Life Questionnaire in order to assess the quality of life in patients with strabismus. We have followed previous published guidelines on translation process to ensure the equivalence between the original and translated versions. The final version was applied in a pilot study to evaluate concordance and its reliability and reproducibility as a tool to be used in future studies. Results: The translation and counter translation processes of the Adult Strabismus Quality of Life Questionnaire were conducted according to preestablished protocols. The analysis of the results obtained in the test-retest application of the questionnaire in a sample of 30 participants revealed a correlation coefficient of 0.67, which was deemed satisfactory for the validation process of this tool. Conclusion: The Adult Strabismus Quality of Life Questionnaire was translated and validated according to preestablished protocols. The referred questionnaire has been used in studies worldwide, so this process will enable its application to better understand the impact of strabismus in patients' quality of life in the Brazilian population.

RESUMO Objetivo: Traduzir e validar o questionário Adult Strabismus Quality of Life Questionnaire (AS-20) para o português brasileiro. Métodos: Estudo transversal para validação linguística e transcultural do questionário Adult Strabismus Quality of Life Questionnaire (AS-20) para avaliação da qualidade de vida em pacientes com estrabismo. Foram seguidas as diretrizes já publicadas sobre o processo de tradução, para garantir a equivalência entre as versões original e traduzida. A versão final foi aplicada em um estudo-piloto para avaliar a concordância e sua confiabilidade e reprodutibilidade, como ferramenta a ser utilizada em estudos futuros. Resultados: Os processos de tradução e contratradução do questionário Adult Strabismus Quality of Life Questionnaire (AS-20) foram realizados de acordo com protocolos preestabelecidos. A análise dos resultados obtidos na aplicação teste-reteste do questionário em uma amostra de 30 participantes revelou coeficiente de correlação de 0,67, que foi considerado satisfatório para o processo de validação desse instrumento. Conclusão: O questionário Adult Strabismus Quality of Life Questionnaire (AS-20) foi traduzido e validado de acordo com protocolos preestabelecidos. O referido questionário vem sendo utilizado em estudos ao redor do mundo e, portanto, esse processo possibilitará sua aplicação para melhor compreensão do impacto do estrabismo na qualidade de vida dos pacientes da população brasileira.

Prevalence and Risk Factors of self-reported dry eye in Brazil using a short symptom questionnaire.

To evaluate dry eye prevalence and investigate associated risk factors in Brazil by applying a short questionnaire of symptoms and risk factors. A cross-sectional study of 3,107 participants from all the five different geopolitical regions of Brazil. Overall prevalence of dry eye in this study population was 12.8%. Dry eye previous diagnosis was reported by 10.2% and presence of severe symptoms in 4.9%. Logistic regression analysis confirmed some significantly risk factors, such as female sex (Odds Ratio (OR) 1.74; 95% Confidence Interval (CI): 1.12-1.93), age ≥60 year-old (OR 2.00; 95%CI: 1.44-2.77), history of ocular surgery (OR 1.84; 95%CI: 1.30-2.60), contact lens wear (OR 1.93; 95%CI: 1.36-2.73), cancer treatment (OR 3.03; 95%CI: 1.36-6.59), computer use >6 hours per day (OR 1.77; 95%CI: 1.36-2.31), antidepressants (OR 1.61; 95%CI: 1.12-2.31) and anti-allergy (OR 2.11; 95%CI: 1.54-2.89) medications. Nevertheless, when stratified by regions, each one had its own significant factors and inherent characteristics. This is the first study about prevalence and risk factors of dry eye in a large population sample from all regions of Brazil. Dry eye is a common condition in the Brazilian population and prevalence rates varies substantially in the different geographic regions of the country, possibly reflecting climate and socioeconomic discrepancies.

Traumatic avulsion of extraocular muscles: case reports.

We described the clinical, surgical details and results (motor and sensory) of the retrieving procedure of traumatically avulsed muscles in three patients with no previous history of strabismus or diplopia seen in the Department of Ophthalmology, State University of Campinas, Brazil. The slipped muscle portion was reinserted at the original insertion and under the remaining stump, which was sutured over the reinserted muscle. For all three cases there was recovery of single binocular vision and stereopsis.

Satisfaction with ophthalmology residency training from the perspective of recent graduates: a cross-sectional study.

BACKGROUND: Few studies have evaluated satisfaction with medical residency programs from the perspective of residents or recent graduates. Knowledge of current conditions of teaching might help to identify deficiencies and to provide adequate training. So, the aim of this study was to assess the satisfaction with residency training and to identify deficiencies in this training from the perspective of recent graduates in ophthalmology residency. METHODS: For this purpose, we developed a questionnaire and gaved it to recent graduates in ophthalmology residency in São Paulo, Brazil, from January to December 2010. The questions contained demographic information (age, sex and time of practice in ophthalmology), a Likert scale to evaluate the level of satisfaction with medical residency concerning clinical knowledge, surgical skills and doctor-patient relationship and questions about deficiency in clinical and surgical areas. RESULTS: The areas in which recent residency graduates were very or extremely satisfied were: acquisition of clinical knowledge (89.1%), acquisition of surgical skills (93.4%) and the development of doctor-patient relationship (74.9%). Specific areas of clinical knowledge in which they perceived more deficiency were orbit (48.3%) and ophthalmic pathology (47.9%), and in surgical skills were refractive surgery (65.9%) and orbit (59.2%) CONCLUSIONS: The assessment of the satisfaction with residency training in ophthalmology from the perspective of recent graduates showed high level of satisfaction and identified specific deficiencies in ophthalmic pathology, refractive surgery and orbit.

Assistive technology applied to education of students with visual impairment.

OBJECTIVES: Verify the application of assistive technology, especially information technology in the education of blind and low-vision students from the perceptions of their teachers. METHODS: Descriptive survey study in public schools in three municipalities of the state of São Paulo, Brazil. The sample comprised 134 teachers. RESULTS: According to the teachers' opinions, there are differences in the specificities and applicability of assistive technology for blind and low-vision students, for whom specific computer programs are important. Information technology enhances reading and writing skills, as well as communication with the world on an equal basis, thereby improving quality of life and facilitating the learning process. The main reason for not using information technology is the lack of planning courses. The main requirements for the use of information technology in schools are enough computers for all students, advisers to help teachers, and pedagogical support. CONCLUSIONS: Assistive technology is applied to education of students with visual impairment; however, teachers indicate the need for infrastructure and pedagogical support. Information technology is an important tool in the inclusion process and can promote independence and autonomy of students with visual impairment.

Results of monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus.

OBJECTIVE: To evaluate the results of monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus. INTRODUCTION: Monocular surgery may preserve some muscles if a repeat operation is required, may help to avoid the exposure of the dominant eye to the inherent risks of a surgical procedure and may reduce surgical time. METHODS: We evaluated ninety-two consecutive patients who underwent monocular surgery under peribulbar anesthesia for large-angle horizontal strabismus (angle of 40 prism diopters or greater). Patients were divided into group 1- esotropia and group 2 -exotropia. The postoperative follow-up was at 6 months, when the residual deviation was evaluated. In cases of residual deviations of over 15 PD (prism diopter), a second procedure was indicated. RESULTS: In all patients with preoperative deviations up to 60 PD, residual deviations were under 15 PD. Some patients with preoperative deviations of 65 PD (two in group 1 and four in group 2) and all patients with deviations over 65 PD had residual deviations over 15 PD. The 13 patients who underwent a second procedure experienced successful outcomes. Our ROC curve analysis showed that the cutoff point for obtaining a successful surgical result was 62.5 PD. No patient presented with a major limitation in respect of ocular movement. CONCLUSIONS: Monocular surgery under peribulbar anesthesia can be an alternative for horizontal large-angle strabismus given deviations of up to 60 PD. Monocular surgery did not result in successful outcomes for deviations of over 65 PD.

Use of optical aids by visually impaired students: social and cultural factors.

PURPOSE: To identify conceptions, social and cultural factors regarding the use of optical aids by visually impaired students and to present information to health and educational professionals. METHODS: Qualitative research using spontaneous theater (interactive theater modality based on improvisation) as research instrument. To analyze data, an adapted form of the collective subject discourse technique - procedures for organization of verbal data - was applied. Scenes, gestures, expressions, silences and behaviors were added to the original proposal. The study population included all visually impaired students from elementary public schools, aged 10 to 14 years who attended a resource room in a São Paulo state city. The students were examined at a university low vision service. RESULTS: Little knowledge about the impairment and difficult adaptation to use of optical aids were identified. The students' behavior showed denial of own problems, discomfort on public use of aids and lack of participation in own health decisions. CONCLUSION: Analysis through spontaneous theater session allows the professional to gather information which is not possible to acquire in the health assistance atmosphere. Needs, difficulties and barriers the users found before the prescribed treatment were identified.

Anterior transposition compared to graded recession of the inferior oblique muscle for V-pattern strabismus.

OBJECTIVE: To compare the efficacy of anterior transposition (AT) and graded recession (GR) in the treatment of V- pattern strabismus caused by overaction of the inferior oblique muscle. METHODS: The charts of surgically treated cases of V-pattern strabismus were analyzed retrospectively and the patients classified as AT or GR. Age, initial horizontal deviation, initial V-pattern and the amount of V-pattern correction were compared between the two groups. RESULTS: There was no significant difference in age (p = 0.066), initial horizontal deviation (p = 0.59), initial V-pattern (p = 0.15) or the amount of V-pattern correction (p = 0.78) between the two groups. CONCLUSION: AT is at least as effective as GR in the treatment of V-pattern strabismus caused by overaction of the inferior oblique muscle.