Improvement in patients' quality-of-life following strabismus surgery: evaluation of postoperative outcomes using the Adult Strabismus 20 (AS-20) score

Introduction Quantification of the psychosocial effects of manifest strabismus has been made possible by the introduction of the Adult Strabismus 20 (AS-20) questionnaire. We investigated the effects of strabismus surgery and patient demographics on the pre- and postoperative AS-20 scores. Methods A prospective, cohort study of adult patients undergoing strabismus surgery. Full pre- and postoperative orthoptic measurements were analysed and compared with the AS-20 total scores and its subscales (psychosocial and functional). Any relationship between: gender; direction; and size of preoperative deviation and the changes in AS-20 score was investigated. Results Eighty-six patients were included with a follow-up of 91 days following surgery. Median deviation preoperatively was 30.5 prism diopters (PD) and the median preoperative AS-20 score was 45. Postoperatively, the median deviation was 8 PD and the AS-20 score was significantly (Z = -7.83, P < 0.0001) higher at 73.1. Females have a lower preoperative AS-20 score (P = 0.01) but show a greater improvement in scores following surgery compared with males (P = 0.058). There is a close correlation between change in AS-20 score and change in deviation size (r = 0.291, P = 0.006). Conclusion Strabismus surgery gives a highly significant improvement in quality-of-life scores. Females gain more benefit from surgery and there is a greater improvement in the score with larger changes in deviation size. The smaller the postoperative angle, the larger the final AS-20 score.