Prevalence and associated risk factors for childhood strabismus in Lhasa, Tibet, China: a cross-sectional, school-based study

Abstract

Background To estimate the prevalence of strabismus and associated risk factors among grade one school children in Lhasa, Tibet, China. Methods The Lhasa Childhood Eye Study (LCES) was a cross-sectional, school-based childhood study conducted in Grade one students from primary schools in Lhasa, Tibet, China. Comprehensive ophthalmic examinations and basic systemic examinations were evaluated. A questionnaire survey containing information about children, as well as parents’ information, was sent to the corresponding parents of eligible children. The prevalence of strabismus and its 95% confidence interval was estimated. Univariate and multivariate logistic regression analyses were conducted to determine the associated risk factors. Results A total of 1942 eligible grade one students were enrolled, of which 1856 participants completed all examinations. The average age was 6.83 ± 0.46 years, 53% of participants were boys and 1762 were the Tibetan Minority. Over all, the prevalence of strabismus was 68/1856 (3.7%) (95%CI: 2.81,4.52), with no difference between the ages, genders, ethnicities and body mass index, while tilting one’s head when writing may be a risk factor for strabismus (P = 0.004). Strabismus students had mean best corrected visual acuity of 0.16 ± 0.28(LogMAR), over 50% patients with esotropia were hyperopic, and participants who had stereopsis impairments showed a significant difference between esotropia and exotropia (P = 0.026). Conclusions The prevalence of strabismus in LCES was 3.7%, which is higher than previous reports from Chinese childhood epidemiology studies. Strabismus is a common contributing factor to amblyopia. Tilting one’s head when writing may be a risk factor. Esotropia is more likely to affect stereopsis and be associated with the refractive state of hyperopia. Trial registration The study has finished the clinical registration on Chinese Clinical Trial Registry. (http://www.chictr.org.cn, ChiCTR1900026693).

Observation on the Curative Effect of Microsurgery in 154 Children with Strabismus and Analysis of Its Influencing Factors

“…Once the compensation range of motor fusion is exceeded, obvious eye position deviation will appear, which will damage binocular visual function. The longer the course of the disease, the greater the hindrance to stereoscopic vision development, which is not conducive to postoperative recovery [ 25 , 26 ]. Human stereoscopic vision mainly appears in 3-4 months after birth and develops basically maturely at the age of 3-4.…”

Myopia prevalence and ocular biometry in children and adolescents at different altitudes: a cross-sectional study in Chongqing and Tibet, China

“…Kobashi et al 5 reported that there is a small amount of riboflavin in the human corneal stroma, and the ex vivo corneal stiffness significantly increases after VL (375 nm wavelength) irradiation based on physiological riboflavin. Epidemiological data show that the prevalence of keratoconus, pterygium, dry eye disease, cataract and strabismus is significantly higher in the highlands than in the lowlands2 6–9 and the cornea of the highlanders is thinner than that of the lowlanders 10 11. Our previous study also found that the prevalence of myopia among children and adolescents in Tibet was lower than that in the plains 12.…”

Binocular vision parameters and body mass index

“…In a cross-sectional study involving 1856 grade 1 students from primary schools, He et al found that BMI was not a risk factor for strabismus using multiple logistic regression [41]. The first possibility is that, as participants had a mean (SD) BMI of 15.74 (1.80), fewer individuals may have had both extremes of BMI.…”

“…The first possibility is that, as participants had a mean (SD) BMI of 15.74 (1.80), fewer individuals may have had both extremes of BMI. The second possibility is that BMI could be less influential on strabismic [13] than on non-strabismic binocular vision anomalies [14], as they tested the effect of BMI in children with strabismus [41], whereas our participants had no manifest deviation for distance or near. The third possibility is that this outcome might be due to the difference in the age of participants between both studies, as He et al [41] included children with a mean (SD) age of 6.83 (0.46), who were younger than our participants (age range: 19 -25 years), as disparity in binocular vision parameters might be seen even between normal children and adults [42].…”