Protocol - Personal and Family History of Strabismus
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
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 Category | Required |
---|---|
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
Standard | Name | ID | Source |
---|---|---|---|
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 VariablesVariable Name | Variable ID | Variable Description | dbGaP Mapping | |
---|---|---|---|---|
PX111001_Abnormal_Ocular_Features | ||||
PX111001110000 | Do you have any abnormal ocular features? more | Variable Mapping | ||
PX111001_Amblyopia_Crossed_Wandering_Eye_Ever | ||||
PX111001010000 | Have you ever had a crossed or wandering eye more | Variable Mapping | ||
PX111001_Coloboma_Absence_Defect_Ocular_Tissue | ||||
PX111001080000 | Do you have a coloboma? (Absence or defect more | Variable Mapping | ||
PX111001_Details_Question_1_To_6 | ||||
PX111001070000 | If you answered YES to any of the above more | N/A | ||
PX111001_Details_Question_8_To_13 | ||||
PX111001140000 | If you answered YES to any question above more | 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 | 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 | 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 | 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 | 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 | N/A | ||
PX111001_Retinal_Defect_Tear_Detachment | ||||
PX111001120000 | Do you have any retinal defects? (retinal more | Variable Mapping | ||
PX111001_Tilt_Head_Looking_Straight_Ever | ||||
PX111001030000 | Do you ever tilt your head when looking straight? | N/A |
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.