We found no differences in composite HRQOL scores for children who wore spectacles and those who did not using Child IXTQ, Proxy IXTQ, Child PedsQL, and Proxy PedsQL HRQOL instruments. Nevertheless, assessment of parental HRQOL using the Parent IXTQ revealed that parents of children who wore spectacles had worse HRQOL than parents of children who did not wear spectacles. Parental HRQOL questions that scored lower in the spectacle group were related to worry about permanent damage to their child’s eyes, longterm eyesight, surgery, self-consciousness, and teasing.
Although the PedsQL has been widely used in nonophthalmic medical conditions, there are few reports of its use in vision disorders. The PedsQL has been used in congenital/infantile cataract10
and also in children with visual impairment and refractive error.11
In the study of visual impairment and refractive error by Wong and colleagues,11
adolescents (aged 11 to 18 years) with visual impairment were found to have lower HRQOL than those without visual impairment, but they found no association between refractive error and HRQOL and the effect of spectacles per se was not studied. In the present study we aimed to minimize the potential effect of reduced visual acuity on HRQOL by including only subjects with normal best-corrected visual acuity and found that spectacle wear made no difference to overall HRQOL scores using the PedsQL child and proxy reports.
Proxy rating of HRQOL is often used when assessing HRQOL in children due to the challenges of acquiring reliable self-reported data. Although there were no overall differences between spectacle wearers and nonspectacle wearers using Proxy IXTQ and Proxy PedsQL, some differences between groups began to emerge with individual questions related to teasing and self-perception when using the Proxy IXTQ (). Previous studies have reported an increase in physical and verbal bullying in children wearing spectacles,7
but these data were reported in interviews with individual children. It is interesting that in the present study, proxy reporting of HRQOL identified concerns regarding teasing in the spectacle wearing group at the individual item level, whereas these concerns were not reported by the children. We have previously reported a greater proportion of subnormal HRQOL scores in children with intermittent exotropia using the Proxy IXTQ than with the Child IXTQ when compared with their respective controls.12
Further study is needed to better understand reasons for differences between child and proxy reporting of HRQOL in this population.
We found that parental HRQOL scores were lower (worse HRQOL) for parents of children who wore spectacles than for parents of children who did not wear spectacles, using the Parent IXTQ. All questions in the Parent IXTQ address worry about different aspects of their child’s eye condition and a variety of concerns were highlighted in the individual questions that showed a significant difference between groups (). Two questions regarding possible surgery () showed significantly lower scores for parents of spectacle wearers. Nevertheless, it is unknown whether or not this concern regarding potential surgery relates specifically to refractive error or another aspect of eye health.
Our study may be limited by a small sample size when we conclude that there were no differences in HRQOL between spectacle and nonspectacle wearers in Child IXTQ, Proxy IXTQ, Child PedsQL, and Proxy PedsQL, but the 95% confidence intervals around the differences suggest that we have not missed a large effect (). In contrast, the differences in parental HRQOL are significant and noteworthy. An additional limitation is the high frequency of maximum scores (100) for many items, creating a ceiling effect, reducing our ability to find a difference between spectacle and nonspectacle wearers. Nevertheless, a proportion of respondents rated many items as less than the maximum score, and our current report highlights these differences.
In conclusion, we found that spectacle wear in children did not affect Child HRQOL as measured by the Child IXTQ or Proxy IXTQ, but spectacle wear was associated with reduced HRQOL of the parents themselves as measured using the Parent IXTQ. Investigators should account for spectacle wear when using the Parent IXTQ.