• Cornea/External Disease, Pediatric Ophth/Strabismus

    Review of: Association of allergic conjunctivitis with health-related quality of life in children and their parents

    Zhang S, Li J, Liu R, et al. JAMA Ophthalmology, in press

    This prospective study assessed the relationship between allergic conjunctivitis and health-related quality of life (QOL) in children and their parents.

    Study design

    Researchers conducted this study at a single Chinese tertiary referral center between November 2019 and January 2020. They enrolled 92 children (ages 5 to 18 years) with allergic conjunctivitis, 96 healthy children and the parents of both groups. Both children and parents were age-matched; children were also matched for visual acuity. The study group was subdivided into cohorts with vernal or atopic keratoconjunctivitis (VKC or AKC), and seasonal or perennial allergic conjunctivitis (SAC or PAC).

    Using the Pediatric Quality of Life Inventory, Version 4.0, the authors scored quality of life from 0 to 100, with higher scores indicating better QOL and fewer negative aspects. Allergic conjunctivitis was diagnosed according to the Academy’s diagnostic criteria.


    The most common type of allergic conjunctivitis was PAC (39%), followed by SAC (28%), VKC (25%) and AKC (8%). The median disease duration was 12 months, and most children (72%) had previously received treatment. Rhinitis was the most common comorbidity (87%), followed by eczema (17%).

    In the study group, children with VKC, AKC or higher corneal fluorescein staining scores had the most prominent decline in QOL. Children’s QOL scores revealed that they tended to perform poorly in school while parents’ scores showed that they were worried, particularly about treatment efficacy.


    This study may have a selection bias as it was performed in the corneal clinic of a tertiary ophthalmic center where patients may have more severe conditions. Because the study was conducted in an economically developed part of China, socioeconomic status could have also impacted QOL. Although there are QOL questionnaires for allergic rhinitis and asthma, there are no allergic conjunctivitis-specific questionnaires. It may not be possible to extrapolate these findings to the entire population because the study excluded individuals with a history of mental disorders and systemic diseases such as diabetes.

    Clinical significance

    Allergic conjunctivitis is a major public health issue that negatively affects the QOL in children and their parents. As eye conditions play a role in patients’ psychological and emotional health, clinicians should consider overall health beyond ocular problems and be aware that allergic conjunctivitis may trigger worry, anxiety, depression and other psychological stress. A detailed assessment of QOL would be useful and help improve patient outcomes. The outcomes of this study also reveal an association between allergic conjunctivitis and poor performance in school, highlighting the need for closer monitoring or interventions. In addition, the authors note the need for more communication with parents regarding treatment and prognosis. These findings also show that care for allergic conjunctivitis and other chronic conditions should focus on both patients and their families.