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Protocol - Personal and Family History of Strabismus

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Description

A series of self-administered questions to assess family and personal history of strabismus, including history of treatments and surgeries.

Specific Instructions

None

Availability

Available

Protocol

1. Have you ever had a crossed or wandering eye (amblyopia)?

[ ] yes

[ ] no

[ ] Im not sure

2. Have you ever had double vision?

[ ] yes

[ ] no

[ ] Im not sure

3. Do you ever tilt your head when looking straight?

[ ] yes

[ ] no

[ ] Im not sure

4. Have you ever undergone eye muscle surgery?

[ ] yes

[ ] no

[ ] Im not sure

5. Have you ever worn a patch or used eye drops (atropine penalization) for eye correction?

[ ] yes

[ ] no

[ ] Im not sure

6. Have you ever worn glasses or contacts?

[ ] yes

[ ] no

[ ] Im not sure

7. If you answered YES to any of the above questions (questions 1-6), please provide further details (i.e. age of onset of eye condition, dates of surgery, name of procedure if known, reason for glasses, etc.) _______________

8. Do you have a coloboma? (Absence or defect of ocular tissue ranging from a small pit in the optic disk to extensive defects in the iris, ciliary body, choroid, retina, or optic disk)

[ ] yes

[ ] no

[ ] Im not sure

9. Do you have microphthalmia? (Abnormally small eye)

[ ] yes

[ ] no

[ ] Im not sure

10. Do you have epibulbar dermoids? (Eye tumors that are not recurrent or progressive)

[ ] yes

[ ] no

[ ] Im not sure

11. Do you have any abnormal ocular features? (eg. epicanthal folds-tissue overlapping the nasal corner of the eye, telecanthus- increased distance between the inner corners of the eyes, slanting of the palpebral fissure(s)-opening for the eyes between the eyelids?)

[ ] yes

[ ] no

[ ] Im not sure

12. Do you have any retinal defects? (retinal tears, detachments, etc.)

[ ] yes

[ ] no

[ ] Im not sure

13. Do you have any visual impairment other than previously noted?

[ ] yes

[ ] no

[ ] Im not sure

14. If you answered YES to any question above (questions 8-13), please describe: ______

Family Ocular History Chart:

Please complete by indicating as appropriate:

15. Glasses before age 6:

[ ] Mother

[ ] Father

[ ] Brother

[ ] Sister

[ ] ? sibling through mother/father

[ ] Grandfather/mother

[ ] Aunt/uncle

[ ] Other (specify ____________)

16. Patching:

[ ] Mother

[ ] Father

[ ] Brother

[ ] Sister

[ ] ? sibling through mother/father

[ ] Grandfather/mother

[ ] Aunt/uncle

[ ] Other (specify ____________)

17. Eye muscle surgery:

[ ] Mother

[ ] Father

[ ] Brother

[ ] Sister

[ ] ? sibling through mother/father

[ ] Grandfather/mother

[ ] Aunt/uncle

[ ] Other (specify ____________)

Personnel and Training Required

These questions may be self-administered (as in the source protocol) or administered by an interviewer with a pencil and paper or computer-assisted interview.

The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e. tested by an expert) at the completion of personal interviews*.

*There are multiple modes to administer this question (i.e., pencil and paper and computer-assisted interviews)

Equipment Needs

Either a pencil and paper or computer-assisted instrument may be used. If a computer-assisted instrument is used, computer software may be necessary to develop the instrument. The interviewer will require a laptop computer/handheld computer to administer a computer-assisted questionnaire.

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered questionnaire

Lifestage

Toddler, Child, Adolescent, Adult

Participants

Individuals aged ≥ 1 year.

Questions are asked of a parent or guardian if the child is a minor

Selection Rationale

Strabismus can be related to a number of underlying ocular conditions. This protocol collects comprehensive information about the clinical features that can predispose to strabismus and amblyopia. Family history is an important risk factor for strabismus and this protocol also includes questions asking about disease in family members.

Language

English

Standards
StandardNameIDSource
Logical Observation Identifiers Names and Codes (LOINC) Pers fam hx strabismus proto 62696-0 LOINC
Human Phenotype Ontology Strabismus HP:0000486 HPO
caDSR Form PhenX PX111001 - Personal And Family History Of Strabismus 5973143 caDSR Form
Derived Variables

None

Process and Review

Not applicable.

Protocol Name from Source

Childrens Hospital Boston, Participant Contact Details and Medical Questionnaire, 2008

Source
Childrens Hospital Boston Center for Strabismus Research, Genetic Studies of Strabismus, Congenital Cranial Dysinnervation Disorders (CCDDs) and their associated anomalies.

Participant Contact Details and Medical Questionnaire, 2008.
General References

Engle EC. (2007). Oculomotility disorders arising from disruptions in brainstem motor neuron development. Arch Neurol, 64(5):633-7.

Engle EC, Andrews C, Law K, Demer JL. (2007). Two pedigrees segregating Duanes retraction syndrome as a dominant trait map to the DURS2 genetic locus. Invest Ophthalmol Vis Sci, 48(1):189-93.

Protocol ID

111001

Variables
Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX111001_Abnormal_Ocular_Features
PX111001110000 Do you have any abnormal ocular features? more
(eg. epicanthal folds-tissue overlapping the nasal corner of the eye, telecanthus- increased distance between the inner corners of the eyes, slanting of the palpebral fissure(s)-opening for the eyes between t show less
Variable Mapping
PX111001_Amblyopia_Crossed_Wandering_Eye_Ever
PX111001010000 Have you ever had a crossed or wandering eye more
(amblyopia)? show less
Variable Mapping
PX111001_Coloboma_Absence_Defect_Ocular_Tissue
PX111001080000 Do you have a coloboma? (Absence or defect more
of ocular tissue ranging from a small pit in the optic disk to extensive defects in the iris, ciliary body, choroid, retina, or optic disk) show less
Variable Mapping
PX111001_Details_Question_1_To_6
PX111001070000 If you answered YES to any of the above more
questions (questions 1-6), please provide further details (i.e. age of onset of eye condition, dates of surgery, name of procedure if known, reason for glasses, etc.) show less
N/A
PX111001_Details_Question_8_To_13
PX111001140000 If you answered YES to any question above more
(questions 8-13), please describe. show less
N/A
PX111001_Double_Vision_Ever
PX111001020000 Have you ever had double vision? Variable Mapping
PX111001_Epibulbar_Dermoids_Eye_Tumor
PX111001100000 Do you have epibulbar dermoid? (Eye tumors more
that are not recurrent or progressive) show less
N/A
PX111001_Eye_Muscle_Surgery
PX111001040000 Have you ever undergone eye muscle surgery? N/A
PX111001_Eye_Muscle_Surgery_Aunt_Uncle
PX111001170700 Eye muscle surgery: Aunt/uncle N/A
PX111001_Eye_Muscle_Surgery_Brother
PX111001170300 Eye muscle surgery: Brother N/A
PX111001_Eye_Muscle_Surgery_Father
PX111001170200 Eye muscle surgery: Father N/A
PX111001_Eye_Muscle_Surgery_Grandparent
PX111001170600 Eye muscle surgery: Grandfather/mother N/A
PX111001_Eye_Muscle_Surgery_Half_Sibling
PX111001170500 Eye muscle surgery: 1/2sibling through more
mother/father show less
N/A
PX111001_Eye_Muscle_Surgery_Mother
PX111001170100 Eye muscle surgery: Mother N/A
PX111001_Eye_Muscle_Surgery_Other_Relative
PX111001170800 Eye muscle surgery: Other N/A
PX111001_Eye_Muscle_Surgery_Other_Relative_Specify
PX111001170900 Specify other relative. N/A
PX111001_Eye_Muscle_Surgery_Sister
PX111001170400 Eye muscle surgery: Sister N/A
PX111001_Glasses_Before_6_Aunt_Uncle
PX111001150700 Glasses before age 6: Aunt/uncle N/A
PX111001_Glasses_Before_6_Brother
PX111001150300 Glasses before age 6: Brother N/A
PX111001_Glasses_Before_6_Father
PX111001150200 Glasses before age 6: Father N/A
PX111001_Glasses_Before_6_Grandparent
PX111001150600 Glasses before age 6: Grandfather/mother N/A
PX111001_Glasses_Before_6_Half_Sibling
PX111001150500 Glasses before age 6: 1/2sibling through more
mother/father show less
N/A
PX111001_Glasses_Before_6_Mother
PX111001150100 Glasses before age 6: Mother N/A
PX111001_Glasses_Before_6_Other_Relative
PX111001150800 Glasses before age 6: Other N/A
PX111001_Glasses_Before_6_Other_Relative_Specify
PX111001150900 Specify other relative. N/A
PX111001_Glasses_Before_6_Sister
PX111001150400 Glasses before age 6: Sister N/A
PX111001_Glasses_Contacts_Ever
PX111001060000 Have you ever worn glasses or contacts? Variable Mapping
PX111001_Microphthalmia_Abnormally_Small_Eye
PX111001090000 Do you have microphthalmia? (Abnormally small eye) N/A
PX111001_Other_Visual_Impairment
PX111001130000 Do you have any visual impairment other than more
previously noted? show less
N/A
PX111001_Patching_Aunt_Uncle
PX111001160700 Patching: Aunt/uncle N/A
PX111001_Patching_Brother
PX111001160300 Patching: Brother N/A
PX111001_Patching_Father
PX111001160200 Patching: Father N/A
PX111001_Patching_Grandparent
PX111001160600 Patching: Grandfather/mother N/A
PX111001_Patching_Half_Sibling
PX111001160500 Patching: 1/2sibling through mother/father N/A
PX111001_Patching_Mother
PX111001160100 Patching: Mother N/A
PX111001_Patching_Other_Relative
PX111001160800 Patching: Other N/A
PX111001_Patching_Other_Relative_Specify
PX111001160900 Specify other relative. N/A
PX111001_Patching_Sister
PX111001160400 Patching: Sister N/A
PX111001_Patch_Eye_Drops_Correction_Ever
PX111001050000 Have you ever worn a patch or used eye drops more
(atropine penalization) for eye correction? show less
N/A
PX111001_Retinal_Defect_Tear_Detachment
PX111001120000 Do you have any retinal defects? (retinal more
tears, detachments, etc.) show less
Variable Mapping
PX111001_Tilt_Head_Looking_Straight_Ever
PX111001030000 Do you ever tilt your head when looking straight? N/A
Ocular
Measure Name

Personal and Family History of Strabismus

Release Date

February 26, 2010

Definition

Self-administered questions to assess personal and family history of strabismus.

Purpose

Strabismus can cause blindness due to amblyopia if not detected in early childhood. Determining those who have a personal and/or family history of the disease identifies higher risk individuals.

Keywords

Ocular, Eye, Strabismus, Family history of eye disease, Personal history of eye disease, Amblyopia, Double vision, Glasses and contact lens use, Abnormal ocular features, Retinal defects, Visual impairments, Eye muscle surgery, Eye patching, Childrens Hospital Boston Center for Strabismus Research, Coloboma, Microphthalmia, Epibulbar dermoids

Measure Protocols
Protocol ID Protocol Name
111001 Personal and Family History of Strabismus
Publications

There are no publications listed for this protocol.