Burden of ocular motility disorders at a Tertiary Care Institution: A case to enhance secondary level eye care

Abstract

Aim:To evaluate the profile of strabismus and amblyopia in patients presenting to a tertiary care institution in order to understand the disease burden.Materials and Methods:A retrospective, prospective hospital-based observational study was conducted at a tertiary level eye care hospital in India. All patients with strabismus or amblyopia who presented over a 1-year period were identified and referred to the squint clinic, where they were evaluated with a detailed clinical history and examination.Results:A total of 24475 patients were evaluated, of which 1950 had strabismus or amblyopia. The overall magnitude of amblyopia and strabismus was 2.0% [95% confidence interval (CI), 1.8-2.2)] and 6.9% (95% CI, 6.6-7.2), respectively. About 20% of those seeking an ophthalmic consultation were children and they constituted over half of the population referred to the squint clinic. Among younger children, the burden of amblyopia and strabismus was 84.4% and 26.6%, respectively. Among the referred patients, strabismus was noted in 84.6% (N = 1649), most of the cases of which was of the comitant subtype (78.1%, N = 1288) with an equal distribution of exotropia and esotropia. Paralytic [12.9% (N = 251)] and restrictive [4.7% (N = 85)] squint constituted the remaining burden of strabismus.Conclusion:Strabismus and amblyopia affect a sizeable proportion of patients presenting to a tertiary care ophthalmology setup. A significantly higher burden is present in the pediatric population. The majority of the cases of strabismus are of a comitant variety, which do not merit tertiary level eye care. There is a need to improve pediatric eye care at a secondary level to reduce the immense burden on tertiary referral centers.

The epidemiology and disease pattern of pediatric ocular morbidities in Western India: The National Institute of OphthalMology AmBlyopia StUdy in Indian Paediatric EyeS (NIMBUS) study report 1

“…[ 13 ] In a hospital-based study conducted in North India, 6.9% of the study population of 24,475 patients had strabismus. [ 19 ] Following age stratification, the authors noted that 14.8% of patients aged up to 12 years had strabismus, which was greater than in our study (4.95%). [ 19 ] Previous hospital-based studies from other parts of the world have reported a higher prevalence of strabismus, including 17.9% in Ethiopia and 22% in Cameroon.…”

“…[ 19 ] Following age stratification, the authors noted that 14.8% of patients aged up to 12 years had strabismus, which was greater than in our study (4.95%). [ 19 ] Previous hospital-based studies from other parts of the world have reported a higher prevalence of strabismus, including 17.9% in Ethiopia and 22% in Cameroon. [ 20 , 21 ] The prevalence is marginally higher than the rates reported in other multi-ethnic population-based studies such as the MultiEthnic Pediatric Eye Disease Study (MEPEDS) from the USA (African Americans and Hispanics: 2.5%; Asians and non-Hispanic whites: 3.24%), the Strabismus, Amblyopia, and Refractive Error in Singaporean Children Study (STARS) from Singapore (0.8%), the Baltimore Pediatric Eye Disease Study (BPEDS) from the USA (Whites: 3.3%; African Americans: 2.1%) and from the UK (2.4%), Australia (2.8%), Brazil (1.4%), and Japan (1.28%).…”

“…A similar spectrum has also been observed with other hospital-based studies and population-based studies. [ 1 , 2 , 4 , 8 - 13 , 16 , 17 , 19 ] Overall, hospital-based data show greater rates of morbidity than population-based studies. Because most population-based studies reported in the literature are conducted among the general population, they may provide reliable information about disease prevalence in the real world.…”

Study of clinico-etiological profile of patients with paralytic and restrictive strabismus

“…after getting recognized as contributing factor in vision loss and impaired binocular function in children, it has been given due attention, in the recent thrust on paediatric ophthalmology in the Vision 2020 initiative. 5 Strabismus causes grave ocular dysfunction including double vision, eyestrain, vision loss, poor depth perception as well as cosmetic stigma among patients. Psychosocial difficulties relating to socially noticeable strabismus persist into teenage and adult years.…”

Commentary: Reoperation following strabismus surgery among Medicare beneficiaries: Associations with geographic region, academic affiliation, surgeon volume, and adjustable suture technique - Operations again! What lessons do we gain?

“…A recently published study from our centre has shown the overall magnitude of strabismus to be 6.9% among the patients visiting the outpatient department. [ 1 ] Hence, strabismus surgery constitutes a sizeable number of the commonly performed ophthalmic surgeries. The most common causes of reoperations in strabismus include an overcorrection or an undercorrection.…”