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The impact of strabismus on psychosocial health and quality of life

We often forget that individuals who experience eye difficulties are not only affected by the issues that are caused by vision impairment but also by society’s perception of them. This occurs especially when vision abnormality is visible and consequently, appearance differs from other people who do not have specific vision problems. In this blog post, we discussed how strabismus impacts overall well-being. Our source for this blog post was an article titled ”The impact of strabismus on psychosocial health and quality of life: a systematic review”.

According to a recent study, the global prevalence of strabismus is estimated to be 1.93 %. This indicated that there are at least 148.61 million individuals with strabismus worldwide. Individuals with strabismus are thought to be impacted to varying degrees depending on their strabismic angle, the direction of deviation, age, sex, presence or absence of diplopia, and visual acuity of the weaker eye. Despite this, it’s critical to understand how the difficulties faced by children with strabismus differ from those faced by adults.

Children

Decreased quality of life for the child

For numerous reasons, children and teenagers with strabismus experience decreased quality of life. Preconceptions, unfavorable attitudes, and misunderstandings from others often contribute to the lower quality of life that children and teenagers with strabismus. Furthermore, they are more likely to be concerned about their eyes, to have negative attitudes and beliefs about themselves, and to have greater psychological discomfort.

Decreased quality of life for parents and family members of children with strabismus

Parents and family members of children with strabismus have a diminished quality of life. If their children have strabismus, parents in some communities have a harder time forming closer bonds, whereas parents in other societies insist that they do not face such issues. Mothers of children with strabismus are more prone to suffer from mental issues and have difficulty forming family relationships. Increased paternal anxiety is thought to have a negative impact on quality of life. Parents of children with intermittent exotropia, which is characterized by a higher angle of deviation and poor control, have a lower health-related quality of life than parents of children with well-controlled exotropia, partly due to increased parental concern. Many parents are concerned about the therapy options used to alleviate their child’s strabismus. Treatment, in particular, poses problems for parents due to the inconvenient nature of attending their child’s appointments and taking time off work. It’s crucial to remember that strabismus poses health and emotional issues for children’s parents and relatives.

Adults

Many of the same prejudices, unfavorable attitudes, and misconceptions towards children with strabismus continue into adulthood. What is more, adults with strabismus are more prone to develop self-doubts and negative attitudes toward themselves. They must also deal with the disorder’s negative influence on employment. Misconceptions about possible therapy among some eye specialists are another barrier that adults with strabismus face. Adult strabismus is associated with social, professional, and treatment challenges, all of which contribute to a decreased quality of life for the individuals. In addition, adults with strabismus are more exposed to potential injuries. Patients with strabismus who are older than 65 years are more likely to suffer a musculoskeletal injury, fracture, or fall as a result of binocular vision. In general, decreased binocular vision has been linked to a 27 % increased risk of musculoskeletal injury, fracture, or fall in the elderly.

The impact of strabismus on psychosocial health and quality of life
The impact of strabismus on psychosocial health and quality of life

Perceptions toward individuals with strabismus

Intelligence

Individuals with strabismus are frequently perceived to be less intelligent. When compared to those who are orthotropic, they are subjectively evaluated as having worse communication skills. Furthermore, patients with esotropia are usually perceived as less clever than those with exotropia, particularly males.

Trustworthiness

The perception of trustworthiness of a person with strabismus depends on the location where a person lives. In the late twentieth century, early beliefs that people with strabismus had a bad moral character were documented in the United States. Later studies confirm these findings, with college students in the US reporting that orthotropic faces are the most sincere, followed by esotropic faces. Exotropic faces were perceived as the least honest by college students in the same survey. Evaluators in Asia, like those in the United States, consider persons with strabismus to be less trustworthy. In Asia, unlike in the United States, esotropic (as opposed to exotropic) faces are seen as less serious and honest.

Attractiveness

The cosmetic aspect of strabismus has a negative influence on affected people on many levels and throughout their lives. According to Eustis and Smith (1987), 17 percent of parents believe that the cosmetic stigma of squint is their child’s most serious condition. Strabismus has a negative impact on one’s beauty that does not diminish with age. In reality, over adolescence and adulthood, assumptions tend to get stronger, with one-fourth of people over 60 thinking “better appearance” to be a primary reason for corrective surgery.

Children are more likely to consider esotropia to be more disturbing than exotropia. This could be because the asymmetry of the face, such as esotropia, is judged as more unpleasant when the asymmetrical feature is positioned more medially.

Ability for hard work

People with strabismus are perceived less positively than those without squint when it comes to their ability to work hard. This has been confirmed by elementary school teachers, who believe that children with exotropia are more capable of hard work than those with esotropia. Adults with strabismus say their disease affected their ability to work as a child, and that their employment disadvantages worsened during their adolescent and adult years. Overall, misconceptions about persons with strabismus’ capacity to execute tough tasks are likely to intensify their career difficulties.

Negative attitudes and misconceptions of employers towards individuals with strabismus

Many adults with strabismus believe there is nothing that can be done to fix the disease or that surgical intervention is fraught with danger. Primary care physicians, optometrists, and ophthalmologists are all at risk of being misled. Adult strabismus is often misunderstood as being difficult or impossible to correct. Furthermore, it is sometimes assumed that individuals with childhood-onset strabismus will not benefit from effective eye alignment in terms of visual function or symptoms, leading to therapy being considered as purely cosmetic with no medical, psychological, or quality-of-life benefits.

Due to misconceptions, surgical intervention is delayed, with a mean time between the onset of strabismus and surgery of around 20 years, even when the condition first appears in childhood. Many people are willing to give up a piece of their life in exchange for relief from strabismus and its side effects. By limiting access to care for affected children and adults, misconceptions about strabismus therapy have a severe influence on the quality of life and psychosocial health.

It is fundamental for healthcare providers to be educated. If doctors are better informed about the potentially devastating effects of strabismus on psychosocial health and quality of life, they can refer patients to the most appropriate ophthalmology sub-specialists. Once the appropriate referrals have been made, treatment can begin that is tailored to the needs of patients with strabismus. Finally, positively improving physical and psychological function in children and adults, will provide opportunities to improve the health of strabismic patients with and without diplopia.

To conclude, strabismus treatment has the potential to improve several aspects of life, both for children and adults. Latter can also improve their financial opportunities by expanding their work options. In addition, society needs to get more knowledge about the strabismus and understand that intelligence, trustworthiness, attractiveness, and all other personality characteristics are not affected by strabismus so that preconceptions do not arise.

Source: Buffenn, A. N. (2021). The impact of strabismus on psychosocial health and quality of life: a systematic review. Survey of Ophthalmology, 66(6), 1051–1064. https://doi.org/10.1016/j.survophthal.2021.03.005

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