Functional limitations recognised by adults with amblyopia and strabismus in daily life: a qualitative exploration.

PURPOSE: Patients' perceptions about the functional impact of amblyopia and strabismus in daily life have not been explored extensively. Therefore, this study aimed to explore the lived experiences of adults with these conditions and understand the functional limitations they face in their day-to-day life. METHODS: A qualitative study design was adopted. Participants over 18 years of age, with a primary diagnosis of amblyopia (with or without strabismus) were recruited from the community and various eye care practices in South Australia and Victoria, Australia. Participants took part in either focus group discussions or individual interviews and described the functional limitations they experienced in their daily life due to their eye condition. These sessions were audio recorded, transcribed verbatim, coded inductively, and analysed iteratively to form emergent themes. RESULTS: Thirty-seven adult participants took part in the study: 23 (62%) had strabismic amblyopia; 5 (14%) anisometropic amblyopia;, 7 (19%) combined-mechanism amblyopia; and 2 (5%) deprivational amblyopia. Their median age was 54 years (range: 21-82 years) and 19 (51%) were female. Participants reported several challenges in performing everyday tasks such as driving (e.g. judging distances, changing lanes), reading (e.g. fine print, reading for prolonged time) and sports (e.g. catching a ball). They also articulated trouble in navigating safely (e.g. using stairs, bumping into objects), performing work-tasks (e.g. taking longer than peers to complete tasks) and other routine tasks (e.g. chopping vegetables with care). CONCLUSIONS: Several functional limitations were encountered by adults living with amblyopia and strabismus. Participants recognised these limitations in their normal day-to-day life and related the challenges they faced to symptoms associated with their eye condition. By presenting rich in-depth qualitative data, the paper demonstrates qualitative evidence of the functional impacts associated with amblyopia and strabismus.

Patient-reported outcome measures in amblyopia and strabismus: a systematic review.

BACKGROUND: Many patient-reported outcome measures (PROMs) have been developed and/or used to measure the impact of amblyopia and strabismus on quality of life (QoL). Identifying the one with superior quality is important for evaluating the effectiveness of novel therapy for amblyopia and for directing improved clinical decision-making in adults considering strabismic surgery. Therefore, the aim of this review is to identify all PROMs previously developed/used to study the impact of amblyopia and/or strabismus on QoL and to appraise the quality and comprehensiveness of content of the disease-specific instruments. METHODS: A systematic search was carried out in the electronic databases of PubMed, Cochrane, Web of Science and PsycINFO. The quality of content and measurement properties of all the disease-specific instruments were assessed using established quality standards. Further, the content of the instruments were examined for comprehensiveness by categorising each item across the eight ophthalmic QoL domains (activity limitation, concerns, emotional well-being, social well-being, economic, convenience, symptoms and mobility). RESULTS: Seventy-one PROMs were identified, out of which 32 were amblyopia- and/or strabismus-specific. Out of all the disease-specific instruments, just four have been subjected to modern psychometric tests and only the adult strabismus questionnaire (AS-20) demonstrated good measurement properties. Most of the amblyopia-specific instruments measured the impact of the treatment of amblyopia on children, while most of the strabismus-specific instruments measured concerns related to appearance and treatment outcome in adults. All instruments have gaps in their content and failed to address QoL comprehensively. CONCLUSION: All the existing amblyopia- and/or strabismus-specific instruments fall short of desired quality and/or comprehensiveness of content. The review identifies the need for developing an instrument with superior quality and discusses potential directions of future research.

Considerations in the routine assessment and treatment of anisometropic amblyopia.

Anisometropic amblyopia has traditionally been treated by direct occlusion with or without refractive correction of the anisometropia. This treatment has generally been considered so successful that practitioners prescribe occlusion for a time and consider treatment complete when visual acuity is no longer improving. The aetiology of anisometropic amblyopia, addressing the functional deficits of the amblyopic system and patient compliance issues, are important to the success of amblyopia treatment in anisometropia and are briefly reviewed in this paper. We propose that, while each case of anisometropic amblyopia may have slightly different attributes, initially they should all be treated with occlusion and full-time spectacle correction. Some presentations may be responsive to individual treatment strategies to correct binocular functions such as stereopsis, accommodative response and fusional vergences.