Mental Health Conditions Associated With Strabismus in a Diverse Cohort of US Adults.

Importance: Greater understanding of the association between strabismus and mental health conditions across sociodemographic backgrounds may inform strategies to improve mental well-being in this population. Objective: To describe the association of strabismus with mental health conditions in a diverse cohort of US adults. Design, Setting, and Participants: This cross-sectional study used data from the National Institutes of Health's All of Us Research Program, an ongoing program launched in 2015. The study included 3646 adults (aged ≥18 years) with strabismus and 3646 propensity score-matched controls. Statistical analysis was conducted from September 12, 2023, to January 29, 2024. Main Outcomes and Measures: Adults with strabismus were propensity score matched on age, gender, race and ethnicity, income, educational level, and insurance status in a 1:1 ratio with adults without strabismus. The prevalences of anxiety, depression, substance use and addiction, bipolar disorder, and schizophrenia spectrum disorder among adults with strabismus were compared with controls. Logistic regression was used to evaluate the association of mental health conditions with sociodemographic factors in each group. Results: This study included 3646 adults with strabismus (median age, 67 years [IQR, 53-76 years]; 2017 women [55%]) and 3646 propensity score-matched controls (median age, 67 years [IQR, 53-76 years]; 2017 women [55%]). Individuals with strabismus had higher prevalences of anxiety (1153 [32%] vs 519 [14%]; difference, 17%; 95% CI, 15%-19%; P < .001), depression (1189 [33%] vs 514 [14%]; difference, 19%; 95% CI, 17%-20%; P < .001), substance use and addiction (116 [3%] vs 51 [1%]; difference, 2%; 95% CI, 1%-3%; P < .001), bipolar disorder (253 [7%] vs 101 [3%]; difference, 4%; 95% CI, 3%-5%; P < .001), and schizophrenia spectrum disorder (103 [3%] vs 36 [1%]; difference, 2%; 95% CI, 1%-3%; P < .001) compared with individuals without strabismus. Among adults with strabismus, higher odds of mental health conditions were associated with younger age (odds ratio [OR], 1.11 per 10-year decrease; 95% CI, 1.06-1.16 per 10-year decrease), female gender (OR, 1.62; 95% CI, 1.41-1.85), Black or African American race and ethnicity (OR, 1.22; 95% CI, 1.01-1.48), low income (OR, 3.06; 95% CI, 2.56-3.67), and high school education or less (OR, 1.58; 95% CI, 1.34-1.85). Conclusions and Relevance: In a diverse and nationwide cohort, adults with strabismus were more likely to have mental health conditions compared with adults without strabismus. Further investigation into the risk factors for poor mental health among adults with strabismus across sociodemographic backgrounds may offer novel opportunities for interventions to improve mental well-being in this population.

Treatment rate of strabismus and amblyopia is associated with the location of pediatric ophthalmologists in the United States.

PURPOSE: To determine whether the geographic density of pediatric ophthalmologists is associated with the rate of children treated for strabismus and amblyopia. METHODS: This cross-sectional study included children treated for strabismus and amblyopia 0-17 years of age with commercial insurance who were included in the Vision and Eye Health Surveillance System. Additionally, pediatric ophthalmologists by state were determined using the American Association for Pediatric Ophthalmology and Strabismus website. Unadjusted linear regression was used to compare the geographic density of pediatric ophthalmologists and the rate of children treated for strabismus and amblyopia by state in 2016. This was repeated using multivariable linear regression, controlling for race, poverty, non-English-speaking children, and insurance coverage for children by state. RESULTS: New York and Mississippi had the highest and lowest rates of treatment of strabismus and amblyopia, with 3.97 and 0.83 children treated per 100 children, respectively. The geographic density of pediatric ophthalmologists was associated with the rate of children treated for strabismus and amblyopia in unadjusted analyses (ß = 0.62, P < 0.001). Further, the geographic density of pediatric ophthalmologists was associated with the rate of children treated for strabismus and amblyopia in adjusted analyses (ß = 0.61, P < 0.001). CONCLUSIONS: The geographic density of pediatric ophthalmologists by state was positively associated with the rate of children treated for strabismus and amblyopia.

Incidence of Strabismus Post-Plaque Brachytherapy in Patients With Uveal Melanoma.

PURPOSE: To determine the incidence and type of strabismus in patients with uveal melanoma treated with plaque brachytherapy. DESIGN: Multicenter, retrospective incidence estimation study. METHODS: A total of 438 eyes of 438 patients with uveal melanoma treated with plaque brachytherapy between October 2011 and May 2021. Intervention was Iodine 125, and Palladium 103 plaque brachytherapy. The variables reviewed included incidence of nonresolving strabismus post-plaque brachytherapy, type of strabismus developed, extraocular muscles operated, and modality of treatment received. RESULTS: A total of 438 patients underwent plaque brachytherapy treatment for uveal melanoma. Eleven patients developed strabismus post-plaque brachytherapy (2.5%, n = 11/438). Of these patients, 5 (1.1%, n = 5/438) developed strabismus immediately postoperation. Specifically, 2 patients (0.5%, n = 2/438) developed strabismus immediately postoperation due to slipped muscles, 2 patients (0.5%, n = 2/438) due to decompensated phorias, and 1 patient (0.5%, n = 1/438) due to a fibrotic muscle. Six patients (1.4%, n = 6/438) developed late-onset sensory strabismus. A total of 355 patients (81.1%, n = 355/438) had their extraocular muscles disinserted during surgery, with the lateral rectus being the most common, accounting for 45.4% (n = 161/355), followed by the superior rectus at 26.8% (n = 95/355). Strabismus surgery was the most common treatment modality, comprising 72.7% (n = 8/11) of patients. CONCLUSIONS: The incidence of strabismus after plaque brachytherapy treatment for uveal melanoma was low and primarily classified as late-onset sensory strabismus. Previous studies may underestimate the long-term incidence of strabismus after plaque brachytherapy by focusing primarily on strabismus present immediately postoperatively.

The distribution characteristics of strabismus surgery types in a tertiary hospital in the Central Plains region during the COVID-19 epidemic.

OBJECTIVE: This study aimed to analyze the distribution of different types of strabismus surgery in a tertiary hospital in Central China during the three-year period of the COVID-19 pandemic. METHODS: A retrospective analysis was conducted on the clinical data of strabismus patients who underwent surgery and were admitted to the Department of Strabismus and Pediatric Ophthalmology at the First Affiliated Hospital of Zhengzhou University between January 2020 and December 2022. RESULTS: A total of 3939 strabismus surgery patients were collected, including 1357 in 2020, 1451 in 2021, and 1131 in 2022. The number of surgeries decreased significantly in February 2020, August 2021, and November and December 2022. Patients aged 0-6 years accounted for 37% of the total number of strabismus surgery patientsr. The majority (60%) of all strabismus surgery patients were diagnosed with exotropia, with intermittent exotropia accounting for the highest proportion (53%). There was no statistically significant difference in the proportion of intermittent exotropia and constant exotropia during the three-year period (χ2 = 2.642, P = 0.267 and χ2 = 3.012, P = 0.221, respectively). Among patients with intermittent exotropia, insufficient convergence type was the most common form of strabismus (accounting for over 70%). Non-accommodative esotropia accounted for more than 50% of all internal strabismus cases. CONCLUSION: During the period from 2020 to 2022, the total number of strabismus surgeries in our hospital did not show significant fluctuations, but there was a noticeable decrease in the number of surgeries during months affected by the pandemic. Exotropia accounted for the highest proportion among strabismus surgery patients. Intermittent exotropia was the most common type among patients undergoing surgery for exotropia, and the most prevalent subtype was the insufficient convergence type. The age distribution of patients varied in different months, with a concentration of surgeries for strabismus patients in the 7-12 years old age group during the months of July and August each year.

Prevalence and causes of ocular disorders and visual impairment among preterm children in Ethiopia.

OBJECTIVE: The aim of this study was to determine the prevalence, causes of ocular disorders and visual impairment among preterm children previously admitted to neonatal intensive care units in Addis Ababa, Ethiopia. METHODS AND ANALYSIS: A prospective screening survey was conducted from February to June 2019 at the paediatric eye clinic of Menelik II Hospital. Children who were preterm at birth and who attended the eye clinic were included in the study. Data on demographic and neonatal characteristics, neonatal and maternal comorbidities and ocular disorders were collected. OR and univariate analysis were used to identify predictors of ocular diseases and visual impairment. RESULTS: There were 222 children included in the study with a mean age at presentation of 2.62 years (range 2.08-6.38 years), mean gestational age 34.11 weeks (range 30-36) weeks and mean birth weight 1941.72 g (range 953-3500 g). Nearly two-thirds had ocular disorders with refractive error (51.8%), strabismus (11.3%) and a history of retinopathy of prematurity (ROP) (7.2%) being more common. One-fourth of the children had visual impairment, and the prevalence of amblyopia was 40.1%. Uncorrected refractive errors, strabismus and ROP were causes for visual impairment. CONCLUSION: Visual impairment and amblyopia are common in Ethiopia. There is a need to develop a screening protocol for ocular disorders for preterm children to enhance early detection and prevention of childhood visual impairment.

Occurrence of Dry Eye Disease in Patients With Concomitant Strabismus: A Preliminary Cross-sectional Analysis.

PURPOSE: To determine the effects of strabismus on dry eye parameters. METHODS: In this cross-sectional study, the preliminary assessment of ocular parameters related to dry eye disease was performed in patients with untreated concomitant strabismus. In total, 204 patients with concomitant strabismus and 125 volunteers without strabismus (4 to 30 years old, 170 male and 159 female) were enrolled. The Ocular Surface Disease Index questionnaire (OSDI) was administered, and ocular surface was examined using the Oculus Keratograph 5M (Oculus Optikgeräte GmbH) to collect data on tear film break-up time (TBUT), ocular redness index (based on bulbar conjunctival blood vessel engorgement), and meibomian gland atrophy. Subgroup analysis was performed based on strabismus type (concomitant exotropia, concomitant esotropia, and non-strabismus); age (juvenile versus adults age > 18 years); and 5- to 10-year and 10- to 20-year strabismus course, according to an age of 12 years. RESULTS: Concomitant exotropia and esotropia were reported in 134 and 70 patients, respectively. A total of 125 healthy volunteers were recruited. The three groups showed significant differences in the ocular redness index (right eye: P = .012, left eye: P = .018). In contrast, other parameters were not significantly different. Similarly, no statistical differences in ocular surface indicators were observed when patients were divided by age (P > .05 for all) and the 5- to 10-year and 10- to 20-year strabismus course. The meibomian gland showed varying degrees of atrophy in both the strabismus and non-strabismus groups. CONCLUSIONS: Strabismus does not affect tear film stability with age in this cohort with constant strabismus up to 30 years, indicating that strabismus may not increase the risk of dry eye disease. [J Pediatr Ophthalmol Strabismus. 2024;61(1):30-37.].

[Change in the age spectrum in strabismus surgery]. / Änderung des Altersspektrums in der Strabismus-Chirurgie.

BACKGROUND: The proportion of children undergoing strabismus surgery in the total volume of eye muscle operations appears to have decreased. To verify this we analyzed the age of patients who underwent extraocular muscle (EOM) surgery. METHODS: The data of patients who underwent EOM surgery at the University Eye Hospital Giessen between 1991 and 2019 were reviewed and the numbers of operations in decadal age groups were compared to the German population in the respective period. In addition, the types of strabismus which led to surgery were evaluated. The data pool comprised > 25,000 surgeries involving > 60,000 muscles. RESULTS: In comparison to 1991, in 2019 the proportion of children aged ≤ 10 years decreased from 50.2% to 31.8%, corresponding to a relative decrease of more than one third. The proportion of patients aged > 50 years increased from 6.5% to 22.5%, i.e., by a factor > 3, while the population ≤ 10 years in 2019 was 13% smaller than in 1991 and the population aged > 50 years increased by 37%. The major reason for the decreasing proportion of children was a 53% reduction in surgery for esotropia. We found no apparent changes in the 2nd-5th decades of life. DISCUSSION AND CONCLUSION: The lower proportion of children undergoing EOM surgery appears to indicate an improvement in vision screening during the past 4 decades. The increasing proportion of older patients may result from better information on potential treatment and increased incidence of acquired strabismus with corresponding complaints. The demographic shift played a secondary role. Due to the population structure in Germany, a further increase in the demand for EOM surgery is to be expected.

The effect of previous orbital decompression on outcomes of rectus muscle recession surgery in patients with thyroid ophthalmopathy.

PURPOSE: To evaluate the effect of previous orbital decompression on outcomes of rectus muscle recession surgery in patients with thyroid-associated ophthalmopathy. METHODS: This retrospective study enrolled 55 eyes of 33 patients treated in our hospital for restrictive strabismus caused by thyroid-associated ophthalmopathy. We performed muscle recession for the obviously restricted extraocular muscles, with 6 weeks of follow-up. Surgical outcomes were compared between the orbital decompression group (DG, n=15) and non-orbital decompression group (NDG, n=18). RESULTS: A total of 33 patients with Graves' ophthalmopathy who underwent rectus muscle recession surgery were included. Of these, 15 patients had undergone orbital decompression prior to strabismus surgery, and 18 had not. The two groups did not differ in terms of the preoperative horizontal or vertical ocular deviation, degree of restriction of eye movement, degree of diplopia, or mean number of muscles that underwent surgery (P>0.05). There was no significant difference in the preoperative horizontal or vertical ocular deviation, level of eye movement restriction, degree of diplopia and the success rate of the surgery (P>0.05). CONCLUSION: Rectus muscle recession surgery in patients with thyroid-associated ophthalmopathy during the quiescent period could improve the ocular deviation and diplopia, and orbital decompression performed before strabismus surgery had no significant effect on surgical technique or outcomes of rectus muscle recession surgery.

Incidence, Risk Factors and Management of Postoperative Complications in Horizontal Strabismus Surgery.

OBJECTIVE: To report the incidence, risk factors and management of postoperative complications after horizontal strabismus surgery. DESIGN: Retrospective Cohort study. PARTICIPANTS: The study assessed 1,273 patients with 1,035 cases of exotropia and 238 cases of esotropia, with a minimum 18-month follow-up. METHODS: Retrospective review of strabismus operation patients' medical records included baseline demographics, age at surgery, pre/postoperative visual acuity, and deviation. Complications were categorized as surgical site (infection, scarring, cyst, granuloma, ischemia) and strabismus-related (recurrence, diplopia), with analysis of incidence, risk factors, and management. RESULTS: Among surgical site complications, the incidence of infection, pyogenic granuloma, and anterior segment ischemia were similar between the exotropia (0.3%, 0.3%, 0.2%) and esotropia (0.8%, 0%, 0.4%) groups (p = .221, 0.406, 0.515). In contrast, the esotropia group presented a higher risk of conjunctival inclusion cyst and conjunctival scar than the exotropia group, with incidences of 5.0% vs 2.2% and 6.3% vs 1.3%, respectively (p = .004, <0.001). Regarding strabismus complications, the incidence of early recurrence was not significant between the two groups, with 10.0% in the exotropia group and 10.5% in the esotropia group (p = .553). Older age and poor initial visual acuity were associated with early recurrence (p < .001). The esotropia group had a higher risk of persistent diplopia than the exotropia group, with incidences of 4.2% vs 2.0%, respectively (p = .003). CONCLUSION: Esotropia carries a higher risk of conjunctival inclusion cysts, conjunctival scarring, and persistent diplopia compared to the exotropia group, while both groups exhibit similar rates of early recurrence and other surgical site complications.

Strabismus and Health Related Quality of Life in a pediatric Portuguese population.

Introduction: Strabismus is a common condition among children, and its psychosocial impact has been demonstrated in recent years. The interest in a more comprehensive approach was enhanced by the recognition of health as a four-dimensional concept, arising the term Health-related Quality of Life. Therefore, we aim to evaluate the influence of strabismus in Health-Related Quality of Life of a Portuguese pediatric population. Material and Methods: Case-control prospective transversal study enrolling children between 5 and 12 years old. All had a complete orthoptic and ophthalmological evaluation, followed by an interview with a legal representative to answer the Pediatric Quality-of-Life Inventory 4.0, proxy-version. Results: Seventy-one children were included, 35 in the control group (CG) and 36 in the strabismus group (SG). In the SG, 30 (83.3%) patients had esotropia, 20 (55.6%) had more than 10 prismatic diopters and 26 (72.2%) were already surgically treated. Overall, SG was not statistically different from the CG, showing only mild inferior performance (p > .05). Furthermore, children with exotropia, higher deviations, none or gross stereoacuity and treatment-naïve, scored worse, especially in emotional, social, educational and psychosocial scores although not statistically significant (p > .05). Conclusion: This is the first prospective study addressing HRQoL and strabismus in a pediatric Portuguese population. It would be relevant to further address this issue in order to delineate more effective and global treatment strategies, not only considering ophthalmological goals but also the well-being of both children and guardians.

Trends in the prevalence of common ocular conditions and comparison of ophthalmic outpatient utilisation related to these conditions in children with and without various types of disabilities: analysis of nationwide population-based data from Taiwan, 2014-2019.

OBJECTIVE: The study objectives were to investigate trends in the prevalence of common ocular conditions among children with and without disabilities; to compare the prevalence of these conditions in children with various disabilities; and to compare ophthalmic outpatient utilisation related to these ocular conditions in children with and without disabilities. DESIGN: Repeated cross-sectional nationwide population-based study. SETTING: Nationwide analysis in Taiwan based on National Health Insurance (NHI) claims data and the National Disability Registry, from 2014 to 2019. PARTICIPANTS: All children (aged under 18 years) with a disability in any given year between 2014 and 2019 were included in our analysis. All children with a disability (experimental group) were matched 1:1 with a child of the same age without a disability (control group). Data regarding the children's disability type and status and ocular conditions were obtained from the National Disability Registry and NHI database of Taiwan. OUTCOME MEASURES: (1) The prevalence of myopia, strabismus, astigmatism, amblyopia and hyperopia over time; (2) the prevalence of myopia, strabismus, astigmatism, amblyopia and hyperopia in children with various disabilities; and (3) the association between disability and the use of outpatient vision care. All outcome measures were assessed using data from 2014 to 2019. RESULTS: Among children with disability, the prevalence of myopia increased from 15.97% in 2014 to 18.07% in 2019. The prevalence of strabismus (2.06-3.90%), astigmatism (8.25-9.24%), amblyopia (4.13-4.95%) and hyperopia (3.36-4.58%) also increased over the study period in children with disabilities. The prevalence of strabismus, astigmatism, amblyopia and hyperopia was significantly higher in children with disabilities than in those without disabilities in all years. For example, in 2019, the prevalence values for strabismus, astigmatism, amblyopia and hyperopia were 3.90%, 9.24%, 4.95% and 4.58%, respectively, among children with disabilities, and 0.67%, 5.84%, 1.33% and 1.70%, respectively, for those without disabilities. The prevalence of these conditions varied considerably across disability types. For example, in 2019, the prevalence of strabismus was highest in children with visual disabilities (10.66%; p<0.001); these children also exhibited a high prevalence of amblyopia (24.34%; p<0.001). The prevalence of myopia was high in children with autism (24.77%), but the prevalence of other ocular conditions was not elevated in this group. Regression results indicated that for myopia, children with disability had 0.48 fewer outpatient clinic visits than those without disability (p<0.001). CONCLUSIONS: The prevalence of common ocular conditions and the corresponding vision care required vary across types of disabilities among children. Healthcare policies must account for children at high risk of various ocular conditions, including those with less common disabilities.

Ocular abnormalities in children with developmental delay.

Purpose: To describe the presence of ocular abnormalities in children with developmental delay (DD) and compare with normal children; to analyze associated risk factors, systemic problems, and the possible treatment that can be delivered. Methods: This was a cross sectional, observational study. We included children between one and 18 years, diagnosed as developmental delay in DD group, and next immediate age- and sex-matched children without developmental delay on the same day or during the same period in the control group. Detailed history and neuroimaging findings were noted. Uncorrected visual acuity, best-corrected visual acuity for distance and near, cycloplegic refraction, anterior, and posterior segment examination was carried out. Various ocular problems, delayed visual maturation (DVM), and cortical visual impairment (CVI) were diagnosed based on examination. Data were analyzed statistically, and P value <0.05 was considered as statistically significant. Results: Ninety-four children were included in each group. Mean age was 4.97 ± 3.84 years, and 64.89% were males. In DD group: Most common abnormal neuroimaging finding was gliotic changes; systemic associations: 39 children; 83 children had ocular problems: refractive error-70, strabismus-39, cataract-five, amblyopia-16; DVM-13; CVI-13 children; glasses and vision stimulation were advised in 39 and 65 children, respectively; whereas, in control group: refractive error-36, strabismus-15, cataract-two; amblyopia-20 children. Conclusion: 88.29% of developmental delay children had ocular abnormalities, commonest was refractive error (74.47%); these values were higher than in control group; common risk factors were low birthweight and consanguineous marriage; epilepsy was the most common systemic association.

Bidirectional associations between hyperopia, myopia, astigmatism, and strabismus, and attention-deficit/hyperactivity disorder in children: a national population-based cohort study.

OBJECTIVES: The present study analyzed the reciprocal relationships between four common pediatric ophthalmic diseases (i.e., hyperopia, myopia, astigmatism, and strabismus) and attention-deficit/hyperactivity disorder (ADHD) in children. METHODS: This study enrolled 86,028 children with ADHD and 1,798,673 children without ADHD in the Taiwan Maternal and Child Health Database who were born at any time from 2004 to 2017. Cox proportional hazards regression models were used to estimate the bidirectional relationships of the four ophthalmic diseases with ADHD in children after adjusting for age, sex, and gestational age at birth. Survival curves for time-to-event variables were estimated using the Kaplan-Meier method, and the log-rank test was used to compare the curves. RESULTS: The results indicated that ADHD significantly predicted the occurrence of hyperopia, myopia, astigmatism, and strabismus. Furthermore, hyperopia, myopia, astigmatism, and strabismus significantly predicted the occurrence of ADHD. The time between enrollment and ADHD diagnosis was shorter for patients with ophthalmic diseases than for the control group, and the time between enrollment and ophthalmic disease diagnosis was also shorter for ADHD patients than for the control group. Sex differences were found in the associations between ADHD and ophthalmic diseases. CONCLUSION: Clinicians should monitor children with ADHD for hyperopia, myopia, astigmatism, and strabismus to ensure appropriate treatment, and vice versa.

Gender differences in horizontal strabismus: Systematic review and meta-analysis shows no difference in prevalence, but gender bias towards females in the clinic.

Background: Strabismus is a misalignment of the visual axis that affects 2-3% of the population and can lead to loss of binocular vision. It is currently controversial whether there is a gender difference in the most common form of visual misalignment: horizontal strabismus. Some studies claimed that more females than males have an outward deviation (exotropia), while others concluded that there is no significant gender difference. No previous work has systematically explored gender differences in horizontal strabismus or has compared the results of population-based studies with those of clinic-based studies. Methods: We conducted a systematic review and meta-analysis of studies reporting the prevalence of horizontal strabismus. We included 73 population-based studies and compared their disclosed gender population with that in 141 comparable clinical-based studies. We analysed the data according to gender, strabismus type (esotropia, exotropia), and geographic region/ethnicity. Results: Summary statistics showed a nearly identical prevalence of horizontal strabismus (2.558% for males, 2.582% for females), esotropia (1.386% males vs. 1.377% females), and of exotropia (1.035% males vs. 1.043% females). Meta-analysis results showed that these differences between males and females were not statistically significant (odds ratio (OR) = 1.01; 95% confidence interval (CI) = 0.97-1.10), but that females were significantly more frequent (by 7.50%) in clinic-based studies than males, with 5.00% more females for esotropia, and 12.20% more females for exotropia when adjusted for the population's sex ratio. The extent of the female gender bias differed between geographic regions/societies, with Asians having the lowest bias towards females and Latin American countries having the strongest bias. Conclusions: Males and females have the same prevalence of horizontal strabismus, including exotropia. Females with strabismus seek health care or are brought to clinics significantly more often than males. This is an example of gender bias in health care in favour of females rather than males, apparently because parents - erroneously fearing only cosmetic consequences - are more concerned about strabismus in their daughters than their sons. Societal attitudes towards females, as well as economic factors (insurance status), appear to be relevant factors that determine the magnitude of the gender bias in horizontal strabismus.

Social-emotional issues among children with strabismus higher than among non-strabismus children in Western India.

Purpose: Data on social-emotional aspects among children with strabismus in India are scanty. We compared the emotional symptoms (ES), loneliness and social dissatisfaction (LSD), and self-esteem (SE) and their associated risk factors among children with and without strabismus in India. Methods: A cross-sectional case-control study design was used to recruit 101 children with strabismus aged 8 to 18 years and a control group of 101 children that were age- and gender-matched. Interviews were performed using standardized scales to assess ES, LSD, and SE. Variations in the intensity of ES, LSD, and SE were assessed using multiple classification analysis (MCA). Results: A total of 202 children participated in the study. The mean ES, LSD, and SE scores were 3.4 (standard deviation [SD] 1.9), 48.4 (SD 3.2), and 22.1 (SD 3.8) for the strabismus group and 1.8 (SD 1.5), 33.3 (SD 3), and 31.3 (SD 2) for the non-strabismus group, respectively. Among the strabismus group, the highest levels of mean ES, LSD, and SE scores were observed among children facing problems in performing daily tasks. Amongst the non-strabismus group, children studying at the primary level and those facing neglect had the highest mean scores. In MCA, being affected with strabismus had the highest effect on the intensity of ES, LSD, and SE with a beta (ß) value of 0.223 (P = 0.016), 0.922 (P < 0.001), and 0.853 (P < 0.001). Conclusion: A significantly high proportion of children with strabismus deal with elevated levels of ES, LSD problems, and low SE as compared with non-strabismus children, highlighting the need to address the poor social-emotional health of children.

Vision outcomes in children with fetal alcohol spectrum disorders.

BACKGROUND: Previous studies demonstrated that children with Fetal Alcohol Spectrum Disorders (FASD) are more likely to have vision impairments. However, existing human clinical and epidemiological investigations are few and include limited sample sizes. This study aimed to explore the association between ophthalmologic abnormalities and FASD in a sample of 5-7 year old children in the general population. METHODS: This was a cross-sectional study nested in a larger study intended to estimate the prevalence of FASD in San Diego, California, conducted between 2012 and 2014. Prenatal exposure to alcohol, dysmorphology examinations, and a neurobehavioral testing battery were collected for each child and an FASD diagnosis was assigned. Parents of participating children were asked to release their child's vision screening or diagnostic records. RESULTS: Vision records were obtained for 424 participants in the larger prevalence study. Of these, 53 children were classified as having FASD. A statistically significant association was found between FASD and a diagnosis of strabismus; 5/42 (11.9%) of children who were classified as having FASD had strabismus compared to 6/290 (2.1%) of children who were not classified as having FASD (p = .01). All five cases of strabismus in the FASD group occurred in 19 children classified as having partial fetal alcohol syndrome (pFAS). No association was found between FASD and vision impairment (p = .23), refractive errors (p = .66), glasses/contact lens prescription (p = .30), or having one or more ophthalmological abnormalities (p = .97). CONCLUSIONS: An association between strabismus and FASD, specifically partial FAS, suggests that the effect of alcohol exposure on risk of strabismus must be severe enough to result in facial features consistent with FASD. This emphasizes the importance of vision screening in children with FASD.

Comparison of epidemiologic factors and eye manifestations of twin children with controls.

PURPOSE: The present study was aimed to compare the epidemiological and ocular findings of twin children in comparison with non- twin age matched individuals as their control. METHODS: In this cross sectional study, a total of 90 twins (180 cases) were compared with 182 non- twin matched children. All the study participants were examined by a comprehensive ophthalmic examination including measurement of the best corrected visual acuity (BCVA), cycloplegic refraction, ocular deviation, strabismus as well as the anterior and posterior ophthalmic examinations. Demographic information of children were collected by using an organized questionnaire. Monozygotic twins were considered if there were similarity of their phenotypic characteristics and gender, otherwise the twins were considered as dizygotic. RESULTS: The mirror- image twins (MIT) was defined according to the laterality of symmetrical ocular characteristics of twins. In this study, the mean age of the study participants was 7.08±4.42 and 7.58±3.99 years in twins and non-twins groups, respectively (P=0.253). Among the twins, 27 (30%) were monozygotic. Refractive form of MIT was seen in 5 twins (2.8%). The spherical refractive error was more hyperopic in twins compared to non- twins (P=0.041). BCVA in the twin group (0.07±0.16LogMAR) was significantly worse than non-twins (0.03±0.08LogMAR, P < 0.001) and higher percentage of them were amblyopic (37.2% versus 10.4%, P=0.005). Twin and controls had strabismus in 17.2% and 1.6%, respectively (P < 0.001). Regarding the comparison between mono- and dizygotic twins, more significant percentage of monozygotic twins had amblyopia (P=0.004) and strabismus (P=0.047). Multivariate analysis showed significant correlation among low gestational age and female gender, low birth weight and seizure. CONCLUSION: Female sex, less gestational age, low birth weight, amblyopia and strabismus were significantly higher in twins. Therefore, it is important to check their refractive error, amblyopia and strabismus to prevent their further complications.

Ophthalmic manifestations in children with Down Syndrome in Bogotá, Colombia.

BACKGROUND: To describe the ocular features of a cohort of children with Down Syndrome (DS) in Bogotá, Colombia. METHODS: We performed a cross-sectional study, evaluating 67 children with DS. A pediatric ophthalmologist performed a complete optometric and ophthalmological evaluation of each child, including visual acuity, ocular alignment, external eye examination, biomicroscopy, auto-refractometry, retinoscope in cycloplegia, and fundus examination. Results were reported as frequency distribution tables with percentages for categorical variables and means and standard deviation or median and interquartile ranges for continuous variables, according to their distribution. We used the Chi-square test or Fisher's exact test for categorical variables and ANOVA or Kruskal-Wallis for continuous variables when indicated. RESULTS: A total of 134 eyes from 67 children were evaluated. Males represented 50.7%. The children's age ranged from 8-16 years, with a mean of 12.3 (SD 2.30). The most frequent refractive diagnosis per eye was hyperopia (47%), followed by myopia (32.1%) and mixed astigmatism (18.7%). The most frequent ocular manifestations were oblique fissure (89.6%), followed by amblyopia (54.5%) and lens opacity (39.4%). Female sex was associated with strabismus (P = 0.009) and amblyopia (P = 0.048). CONCLUSION: Our cohort had a high prevalence of disregarded ophthalmological manifestations. Some of these manifestations, such as amblyopia, can be irreversible and severely affect the neurodevelopment of DS children. Therefore, ophthalmologists and optometrists should be aware of the visual and ocular affection of children with DS to assess and provide appropriate management. This awareness could improve rehabilitation outcomes for these children.

Frequency of Amblyopia in strabismus patients presenting to tertiary care hospital.

Objective: The rationale of study was to find the magnitude of amblyopia with reference to type of squint among the strabismus patients visiting Hayatabad Medical Complex Peshawar, Pakistan. Materials and Methods: After ethical approval, a cross sectional study was carried out in the Department of Ophthalmology, Hayatabad Medical Complex, Peshawar, Pakistan, from April 2022 to October 2022, the total number of patients included being 237. Results: Amblyopia was observed in 113 out of 160 (70.6%) cases of uniocular squint, while in alternating squint it was found to be 11 out of 77 (14.2%). Amblyopia in patients with esotropia was seen in 73.2% (107 out of 146), while 59.3% (54 out of 91) exotropia had associated amblyopia. Conclusion: Strabismus amblyopia leads to developmental arrest of vision in early critical years of life. Permanent visual loss can be avoided with comprehensive screening and detailed examination of strabismic patient.

Level of prematurity as a predictor for the activity of retinopathy of prematurity and strabismus.

Objective: To evaluate the prevalence of strabismus in premature children after the screening for retinopathy of prematurity (ROP) and to determine whether the level of prematurity (birth weight and gestation age) can be used as a predictor for both strabismus development and disease activity. Methods: This is a retrospective study, conducted in the Clinic for Eye Disease, section for Pediatric Ophthalmology of the Clinical Centre University of Sarajevo during the period from December 2013 until January 2017. 126 patients were involved. The inclusion criteria were gestational age ≤ 34 weeks, birthweight ≤ 2000 g and performed screening test for ROP. Patients were divided into three groups: patients without ROP, patients with spontaneous regression and patients with active ROP. Results: 52.4% patients were suffering from strabismus (30.2% esotropia, 22.2% exotropia). All the patients with active ROP had esotropia (60.0%). The average birth weight and gestational age were lower in patients with strabismus (1371.3 ± 58.0 g and 29.7 ± 0.4 weeks respectively). Conclusion: Lower gestational age and birth weight of premature children showed the increased probability of strabismus development especially esotropia. Prematurity level was significantly lower in patients with active ROP compared to the rest of the patients. Abbreviations: ROP = Retinopathy of prematurity, ICROP = International Classification of Retinopathy of prematurity, BCVA = best corrected visual acuity.