Risk Factors Associated with Childhood Strabismus

Cotter, Susan A.; Varma, Rohit; Tarczy-Hornoch, Kristina; McKean‐Cowdin, Roberta; Lin, Jesse; Wen, Ge; Wei, Jolyn; Borchert, Mark; Azen, Stanley P.; Torres, Mina; Tielsch, James M.; Friedman, David S.; Repka, Michael X.; Katz, Joanne; Ibironke, Josephine; Giordano, Lydia

doi:10.1016/j.ophtha.2011.06.032

Cited by 145 publications

(94 citation statements)

References 63 publications

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“…30 Data from the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS) and the Baltimore Pediatric Eye Disease Study (BPEDS) also demonstrated that after multivariate analysis, infants with a GA <33 weeks had a considerably higher odds (OR=2.48 ([CI, 1.17–5.25]) for development of strabismus relative to those with GA of ≥33 weeks. 43 Unfortunately, neither study considered BW. Since it is known that BW is correlated with GA, it is possible that the findings observed in these analyses may actually be more attributable to BW than GA.…”

Section: Discussionmentioning

confidence: 99%

“…Well-recognized risk factors for strabismus include anisometropia and refractive error 11,12 , genetics 13,14 , older age of parents 1,15 , maternal cigarette smoking during pregnancy 15,16 , neurodevelopmental impairment 17,18 , low APGAR (Appearance, Pulse, Grimace, Activity, Respiration) scores 19 , craniofacial and chromosomal abnormalities 20,21 , in utero toxin exposure 22 , retinopathy of prematurity (ROP) 23,24 , and caesarian delivery 5,25 . For children who are born premature, there is debate in the literature regarding two other potential risk factors, birth weight (BW) and gestational age (GA) 26,27,28,29 (eTable 1) 1,2,15,23–25,29–33 .…”

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Effect of Gestational Age and Birth Weight on the Risk of Strabismus Among Premature Infants

et al. 2014

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IMPORTANCE Strabismus causes irreversible vision loss if not detected and treated early. It is unclear whether birth weight (BW) and gestational age (GA) are risk factors for strabismus.OBJECTIVE To estimate the effect of BW and GA on the likelihood of premature infants developing strabismus. DESIGN, SETTING, AND PARTICIPANTSIn this longitudinal cohort analysis, we monitored a group of premature children from birth to determine the proportion that developed strabismus and the timing of the first strabismus diagnosis. Multivariable Cox regression analyses assessed the relationships of BW and GA with the development of strabismus. Regression models were adjusted for other risk factors for strabismus, sociodemographic factors, and ocular comorbidities. The analysis included 38 055 otherwise healthy children born prematurely who were enrolled for more than 6 months in a nationwide US managed care network between 2001 and 2011 in communities throughout the United States.EXPOSURES Birth weight less than 2000 g or GA of 32 weeks or less. MAIN OUTCOMES AND MEASURESHazard ratios (HRs) for strabismus with 95% CIs. RESULTSOf 38 055 otherwise healthy children who were born prematurely, 583 received a diagnosis of strabismus later in life. The cumulative incidence of strabismus was 3.0% at 5 years. Controlling for GA and other covariates, infants born with BW less than 2000 g had a 61% increased hazard (HR, 1.61; 95% CI, 1.22-2.13) of developing strabismus. Controlling for BW and other covariates, there was no significant association between strabismus and GA (HR, 0.98; 95% CI, 0.69-1.38). Among premature infants with BW of less than 2000 g, a GA of 32 weeks or less conveyed no additional increased risk for developing strabismus relative to infants born after 32 weeks (HR, 1.27; 95% CI, 0.86-1.88). In contrast, among infants with a GA of 32 weeks or less, BW of less than 2000 g conveyed a 14-fold increase in the risk of strabismus relative to BW of 2000 g or more (HR, 14.39; 95% CI,.CONCLUSIONS AND RELEVANCE Independent of GA, very low BW conferred a large increase in strabismus risk among premature infants. In contrast, independent of BW, GA did not significantly affect the risk of strabismus. Updates to existing guidelines in the pediatric and ophthalmic literature should be considered, highlighting the importance of BW rather than GA and alerting clinicians about the need for careful monitoring of premature infants with low BW for strabismus.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Effect of Gestational Age and Birth Weight on the Risk of Strabismus Among Premature Infants

et al. 2014

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“…13,14,17,48 The rationale for retinal birefringence screening with the PVS device is quite different. Namely, it is a simple, quick test that can be used to refer only affected children to eye care professionals or screen children at regular intervals in a primary care setting to provide early and accurate identification of those who develops trabismus or amblyopia.…”

Section: Discussionmentioning

confidence: 99%

Beyond Screening for Risk Factors

et al. 2014

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IMPORTANCE Commercially available automated vision screening devices assess refractive risk factors, not amblyopia or strabismus, underreferring affected children and overreferring healthy children. Nearly half of affected children are not identified until after age 5 years, when treatment is less effective.OBJECTIVES To determine the diagnostic accuracy of the Pediatric Vision Scanner (PVS), a binocular retinal birefringence scanner, to objectively identify strabismus and amblyopia, and to compare retinal birefringence screening with a widely used automated pediatric screening device.DESIGN, SETTING, AND PARTICIPANTS Three hundred consecutive preschool children (aged 2-6 years) were screened using the PVS and the SureSight Autorefractor at 2 pediatric ophthalmology private practices. A masked comprehensive pediatric ophthalmic examination provided the gold standard for determining sensitivity and specificity for each screening device. MAIN OUTCOMES AND MEASURESThe primary outcome was sensitivity and specificity of the PVS for detecting the targeted conditions, strabismus and amblyopia, in children aged 2 to 6 years. Secondary outcomes included the positive and negative likelihood ratios of the PVS for identifying the targeted conditions. In addition, sensitivity, specificity, and positive and negative likelihood ratios of the SureSight Autorefractor for the targeted conditions were assessed in the same cohort of children. RESULTSOf the 300 patients, 188 had strabismus only, amblyopia only, or both, and 112 had no strabismus or amblyopia. The sensitivity of the PVS to detect strabismus and amblyopia (0.97; 95% CI, 0.94-1.00) was significantly higher than that of the SureSight Autorefractor (0.74; 95% CI, 0.66-0.83). Specificity of the PVS for strabismus and amblyopia (0.87; 95% CI, 0.80-0.95) was significantly higher than that of the SureSight Autorefractor (0.62; 95% CI, 0.50-0.73). CONCLUSIONS AND RELEVANCEThe PVS identified children with strabismus and/or amblyopia with high sensitivity, outperforming the SureSight Autorefractor. Accurate, early detection of these conditions could improve long-term vision outcomes of affected preschool children.

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“…For vision, the incidences of problems such as myopia, hyperopia and astigmatism do not appear to be greater than reported in US preschool children. 54, 55 However, the high rate of strabismus (16.9%) in international adoptees compared to preschool children in the UK (2.1%) 56 and US (2.4%) 57 is of great concern since esotropia is one of the most robust predictors of decreased visual acuity in pre-school children. 58 Our identification of a high rate of strabismus is supported by Gronlund, et al, who reported a prospective study of 72 of 99 children in Western Sweden who were adopted from Eastern Europe during 1993–1997, comparing them to an age- and sex-matched reference group.…”

Section: Discussionmentioning

confidence: 99%

“…64 Low birth weight, common among international adoptees 20, 36 but not analyzed in this study due to limited data, is a risk factor for vision problems, particularly strabismus. 56, 57, 65 Middle ear disease is a leading cause of hearing loss in children, 66 as reflected in the MnIAP cohort where recurrent ear infections post-adoption was identified as an independent risk factor. Duration of institutionalization is an independent risk factor for hearing problems, most likely mediated via high rates of respiratory illness in congregate care settings 36, 67 coupled with overall medical, nutritional and social neglect.…”

Section: Discussionmentioning

confidence: 99%

Vision and Hearing Deficits and Associations with Parent-Reported Behavioral and Developmental Problems in International Adoptees

Eckerle

Hill²,

Iverson³

et al. 2013

Matern Child Health J

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Objectives To determine the occurrence of vision and hearing deficits in international adoptees and their associations with emotional, behavioral and cognitive problems. Methods The Minnesota International Adoption Project (MnIAP) was a 556-item survey that was mailed to 2969 parents who finalized an international adoption in Minnesota (MN) between January 1990 and December 1998 and whose children were between 4–18 years-old at the time of the survey. Families returned surveys for 1906 children (64%); 1005 had complete data for analyses. The survey included questions about the child’s pre-adoption experiences and post-placement medical diagnoses, and the Child Behavior Checklist (CBCL). Multivariate logistic regression assessed associations between hearing and vision problems and problems identified by the CBCL. Information on hearing and vision screening and specific vision and hearing problems was also collected via a telephone survey (HVS) from 96/184 children (52%) seen between June 1999 and December 2000 at the University of Minnesota (U of MN) International Adoption Clinic. Results In both cohorts, 61% of children had been screened for vision problems and 59% for hearing problems. Among those children screened, vision (MnIAP=25%, HVS=31%) and hearing (MnIAP=12%, HVS=13%) problems were common. For MnIAP children, such problems were significant independent predictors for T-scores >67 for the CBCL social problems and attention subscales and parent-reported, practitioner-diagnosed developmental delay, learning and speech/language problems, and cognitive impairment. Conclusions Hearing and vision problems are common in international adoptees and screening and correction are available in the immediate post-arrival period. The importance of identifying vision and hearing problems cannot be overstated as they are risk factors for development and behavior problems.

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Risk Factors Associated with Childhood Strabismus

Cited by 145 publications

References 63 publications

Effect of Gestational Age and Birth Weight on the Risk of Strabismus Among Premature Infants

Effect of Gestational Age and Birth Weight on the Risk of Strabismus Among Premature Infants

Beyond Screening for Risk Factors

Vision and Hearing Deficits and Associations with Parent-Reported Behavioral and Developmental Problems in International Adoptees

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