Importance: Strabismus is common, affecting 2% to 4% of children, but how children and their families are affected in everyday life is poorly understood. Objective: To evaluate the association of strabismus with functional vision and eye-related quality of life in children and their families using the Pediatric Eye Questionnaire (PedEyeQ). Design, Setting, and Participants: This cross-sectional study was conducted between December 2017 and October 2019 and included 91 children with strabismus and 166 visually normal controls across 3 age groups (0-4, 5-11, and 12-17 years) who were enrolled at Mayo Clinic, Rochester, Minnesota, and Retina Foundation of the Southwest, Dallas, Texas. Exposures: Children completed the child PedEyeQ (5 to 11-and 12 to 17-year versions: functional vision, bothered by eyes/vision, social, and frustration/worry domains); parents completed the proxy (0 to 4-, 5 to 11-, and 12 to 17-year versions: functional vision, bothered by eyes/vision, social, frustration/worry, and eye care domains) and the parent PedEyeQ (impact on parent and family, worry about child's eye condition, worry about child's self-perception and interactions, and worry about child's functional vision domains). Rasch-calibrated PedEyeQ scores were calculated for each domain and converted to 0 (worst) to 100. Main Outcomes and Measures: PedEyeQ domain scores Results: Of 91 participants with strabismus, 41 (45.1%) were girls, 74 (81.3%) were white, 4 (4.4%) were Asian, 5 (5.5%) were more than 1 race, 5 (5.5%) were African American, and 2 (2.2%) were American Indian/Alaska Native. Child PedEyeQ domain scores were lower with strabismus vs visually normal controls among children ages 5 to 11 years and the greatest mean (SD) difference was in functional vision (12  points; 95% CI, 6-18; P =.001), and among children ages 12 to 17 years, the greatest mean (SD) difference was in frustration/worry (27  points; 95% CI, 18-36; P <.001). Proxy PedEyeQ domain scores were also lower with strabismus. The greatest difference among children ages 0 to 4 years was in functional vision (13  points; 95% CI, 9-16; P <.001), among children ages 5 to 11 years was in functional vision (26  points; 95% CI, 22-30; P <.001); and among children ages 12 to 17 years was in functional vision (21  points; 95% CI, 12-30; P <.001), social (21  points; 95% CI, 12-30; P <.001), and frustration/worry (21  points; 95% CI, 12-30; P <.001). Parent PedEyeQ domain scores were lower with strabismus; the greatest difference was in worry about child's eye condition (38  points; 95% CI, 34-42; P <.001). Conclusions and Relevance: Strabismus is associated with reduced functional vision and eye-related quality of life in children. Parents of children with strabismus also experience a reduced quality of life. These findings advance our understanding of how strabismus affects children and their families and should be considered when defining patient management goals.
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