Background: The impact of strabismus to the quality of life (QoL) in adult patients has not been assessed and explored in Arab countries. Aims: This study aims to assess the validity and reliability of the Arabic-translated adult strabismus-20 (AS-20) questionnaire in determining the impact of strabismus on health-related QoL (HRQoL) of patients. Settings and Design: A cross-sectional study on the psychosocial and functional scores collected from 161 adult patients with strabismus, diagnosed from 2011 to 2021 in King Abdulaziz University Hospital, Jeddah City. Population with no strabismus manifestation was used as the control group. Subjects and Methods: One hundred and sixty-one adult patients, with a minimum age of 18 years with manifest strabismus, were contacted via phone calls to answer the QoL questionnaire list using Arabic-translated AS-20 questionnaire. Statistical Analysis Used: A model of Alpha (Cronbach) was used to determine the reliability test of the Arabic-translated AS-20 questionnaire. A comparison of two mean scores was performed using an independent t-test or Welsch's t-test, which was only significant at < 0.05 level. Results: The overall AS-20 mean scores for male and female adults were 66.79 ± 28.2, with a total psychosocial and functional mean score of 65.70 ± 30.9 and 67.88 ± 30.8, respectively. In general, female patients have a higher mean score than male patients for all the subscale items, except item 6. The case group, involving strabismic patients, showed significantly lower AS-20 scale mean scores as compared to control (48.53 ± 25.8 vs. 83.48 ± 18.1), with mean scores of 43.85 ± 25.9 and 53.87 ± 24.8 for males and females, respectively. Moreover, excellent overall score was obtained in internal consistency (Cronbach's alpha = 0.918). Conclusions: With its excellent test-retest reliability results, the Arabic version of the AS-20 questionnaire was an applicable tool for assessing strabismus among Arabic-speaking patients. Prominent impact of strabismus on patient's HRQoL was determined by the significantly lower AS-20 scores of the patients than those of the control.
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