Development and application of the Chinese version of the adult strabismus quality of life questionnaire (AS-20): a cross-sectional study

BACKGROUND Patients with strabismus experience visual dysfunction, self-image disorders, low self-esteem, and social and emotional barriers, which adversely influence their health-related quality of life (HRQoL). Currently no strabismus-specific questionnaire is available in China to identify patients' quality of life and to evaluate the effectiveness of strabismus treatment. The aims of the present study were to validate the Chinese-language version of the Adult Strabismus Quality of Life Questionnaire (AS-20) and to evaluate the impacts of strabismus on the quality of life among Chinese strabismus patients. METHODS Two hundred and fifty-five Chinese adults with strabismus, one hundred visually normal adults and one hundred patients with other eye diseases completed the Chinese version of AS-20. Psychometric properties of the Chinese AS-20 were examined by Cronbach's α coefficient, test-retest and split-half reliability, and construct and criterion-related validity. Independent-samples t test and one-way ANOVA analyses were conducted to explore the impact of demographic factors and clinical characteristics on HRQoL in Chinese strabismic adults. RESULTS The final AS-20 in Chinese (AS-C) included 18 items and two subscales: psychosocial (12 items) and function (6 items). The Cronbach's α was 0.908 for overall scale, with 0.913 and 0.808 for 'psychosocial' and 'function' subscales respectively, indicating high internal consistency reliability. The mean of the overall AS-C score among strabismus patients was 62.80 ± 18.94, significantly lower than that in visually normal adults (t = -18.693, P < 0.001), and in patients with other eye diseases (t = -5.512, P < 0.001). CONCLUSIONS The AS-C is a culturally appropriate tool to evaluate the HRQoL in Chinese strabismus adults. The psychosocial health well-being and overall quality of life in strabismic patients should receive greater emphasis.