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Zhang W, Fei N, Wang Y, Yang B, Liu Z, Cheng L, Li J, Xian J, Fu T. Functional changes in fusional vergence-related brain areas and correlation with clinical features in intermittent exotropia using functional magnetic resonance imaging. Hum Brain Mapp 2023; 44:5002-5012. [PMID: 37539805 PMCID: PMC10502682 DOI: 10.1002/hbm.26427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/02/2023] [Accepted: 07/07/2023] [Indexed: 08/05/2023] Open
Abstract
To explore the functional changes of the frontal eye field (FEF) and relevant brain regions and its role in the pathogenesis of intermittent exotropia (IXT) children via functional magnetic resonance imaging (fMRI). Twenty-four IXT children (mean age, 11.83 ± 1.93 years) and 28 normal control (NC) subjects (mean age, 11.11 ± 1.50 years) were recruited. During fMRI scans, the IXT children and NCs were provided with static visual stimuli (to evoke sensory fusion) and dynamic visual stimuli (to evoke motor fusion and vergence eye movements) with binocular disparity. Brain activation in the relevant brain regions and clinical characteristics were evaluated. Group differences of brain activation and brain-behavior correlations were investigated. For dynamic and static visual disparity relative to no visual disparity, reduced brain activation in the right FEF and right inferior occipital gyrus (IOG), and increased brain activation in the left middle temporal gyrus complex (MT+) were found in the IXT children compared with NCs. Significant positive correlations between the fusional vergence amplitude and the brain activation values were found in the right FEF, right IPL, and left cerebellum in the NC group. Positive correlations between brain activation values and Newcastle Control Scores (NCS) were found in the left MT+ in the IXT group. For dynamic visual disparity relative to static visual disparity, reduced brain activation in the right middle occipital gyrus, left cerebellum, and bilateral IPL was found in the IXT children compared with NCs. Significant positive correlations between brain activation values and the fusional vergence amplitude were found in the right FEF and right cerebellum in the NC group. Negative correlations between brain activation values and NCS were found in the right middle occipital gyrus, right cerebellum, left IPL, and right FEF in the IXT group. These results suggest that the reduced brain activation in the right FEF, left IPL, and cerebellum may play an important role in the pathogenesis of IXT by influencing fusional vergence function. While the increased brain activation in the left MT+ may compensate for this dysfunction in IXT children.
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Affiliation(s)
- Weijia Zhang
- Department of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
- Beijing Ophthalmology & Visual Sciences Key LaboratoryCapital Medical UniversityBeijingChina
| | - Nanxi Fei
- Department of Radiology, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Yachen Wang
- Department of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
- Beijing Ophthalmology & Visual Sciences Key LaboratoryCapital Medical UniversityBeijingChina
| | - Bingbing Yang
- Department of Radiology, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Zhihan Liu
- Department of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
- Beijing Ophthalmology & Visual Sciences Key LaboratoryCapital Medical UniversityBeijingChina
| | - Luyao Cheng
- Department of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
- Beijing Ophthalmology & Visual Sciences Key LaboratoryCapital Medical UniversityBeijingChina
| | - Junfa Li
- Department of Neurobiology, School of Basic Medical SciencesCapital Medical UniversityBeijingChina
| | - Junfang Xian
- Department of Radiology, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
| | - Tao Fu
- Department of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren HospitalCapital Medical UniversityBeijingChina
- Beijing Ophthalmology & Visual Sciences Key LaboratoryCapital Medical UniversityBeijingChina
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Laughton SC, Hagen MM, Yang W, von Bartheld CS. Gender differences in horizontal strabismus: Systematic review and meta-analysis shows no difference in prevalence, but gender bias towards females in the clinic. J Glob Health 2023; 13:04085. [PMID: 37651634 PMCID: PMC10471156 DOI: 10.7189/jogh.13.04085] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
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.
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Affiliation(s)
- Sydney C Laughton
- Center of Biomedical Research Excellence in Cell Biology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Molly M Hagen
- School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Wei Yang
- School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Christopher S von Bartheld
- Center of Biomedical Research Excellence in Cell Biology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
- Department of Physiology and Cell Biology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
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Abstract
Strabismus, or misalignment of the eyes, is the most common ocular disorder in the pediatric population, affecting approximately 2%-4% of children. Strabismus leads to the disruption of binocular vision, amblyopia, social and occupational discrimination, and decreased quality of life. Although it has been recognized since ancient times that strabismus runs in families, its inheritance patterns are complex, and its precise genetic mechanisms have not yet been defined. Family, population, and twin studies all support a role of genetics in the development of strabismus. There are multiple forms of strabismus, and it is not known if they have shared genetic mechanisms or are distinct genetic disorders, which complicates studies of strabismus. Studies assuming that strabismus is a Mendelian disorder have found areas of linkage and candidate genes in particular families, but no definitive causal genes. Genome-wide association studies searching for common variation that contributes to strabismus risk have identified two risk loci and three copy number variants in white populations. Causative genes have been identified in congenital cranial dysinnervation disorders, syndromes in which eye movement is limited or paralyzed. The causative genes lead to either improper differentiation of cranial motor neurons or abnormal axon guidance. This article reviews the evidence for a genetic contribution to strabismus and the recent advances that have been made in the genetics of comitant strabismus, the most common form of strabismus.
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Affiliation(s)
- Mayra Martinez Sanchez
- Department of Ophthalmology, Boston Children’s Hospital, Boston, MA, United States
- Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Mary C. Whitman
- Department of Ophthalmology, Boston Children’s Hospital, Boston, MA, United States
- Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
- F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Boston, MA, United States
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Observation on the Curative Effect of Microsurgery in 154 Children with Strabismus and Analysis of Its Influencing Factors. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3597084. [PMID: 34707667 PMCID: PMC8545540 DOI: 10.1155/2021/3597084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
Strabismus is a common ophthalmic disease in the process of child body development, in which the two eyes cannot gaze at the target at the same time, and the incidence of this disease of children is higher. In children with esotropia, exotropia, and up and down strabismus and other typical symptoms, the cause is genetic, innerve, and refractive and regulated, and not receiving timely treatment may lead to stereo vision and diplopia and other phenomena, affecting their learning and life. Surgical treatment is the main treatment for strabismus at present. Traditional orthodontic surgery is performed by doctors under the naked eye, often due to improper operation or suture error and other factors, resulting in more postoperative complications, such as more tissue damage, conjunctival congestion, and muscle suture reaction, which seriously affect the clinical effect of surgical treatment. In recent years, with the continuous development of microsurgical technology, the correction of strabismus under a microscope has been widely carried out in clinic. The operation under the microscope makes the operation more delicate and accurate, overcomes the defects of traditional surgery, and highlights the advantages of minimally invasive surgery. The purpose of this study was to investigate the effect of microsurgical techniques in the treatment of strabismus in children and to analyze the factors influencing the outcome. The results showed that microsurgical strabismus correction in the treatment of strabismus children has short operation time, less intraoperative blood loss, short hospital stay, high efficiency, and less complications, which is worthy of popularization. Age, preoperative strabismus angle, refractive error, distance stereopsis injury, near stereoscopic injury, and duration of disease were all independent influencing factors of postoperative efficacy.
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Yotsukura E, Torii H, Ozawa H, Hida RY, Shiraishi T, Corso Teixeira I, Rautha YVBL, Moraes do Nascimento CF, Mori K, Uchino M, Kurihara T, Negishi K, Tsubota K. Axial Length and Prevalence of Myopia among Schoolchildren in the Equatorial Region of Brazil. J Clin Med 2020; 10:jcm10010115. [PMID: 33396242 PMCID: PMC7794886 DOI: 10.3390/jcm10010115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 12/14/2022] Open
Abstract
The prevalence of myopia is increasing globally, and the outdoor light environment is considered as a possible factor that can retard myopia. The aim of this study was to evaluate the prevalence of myopia and the light environment in Aracati, equatorial Brazil. We surveyed 421 children (421 right eyes; mean age, 10.6 years) and performed ocular examinations that included non-cycloplegic refraction and axial length (AL). Multiple regression analyses were performed to identify factors affecting myopia such as time spent outdoors and in near work. We measured illuminance and violet light irradiance in Aracati. The mean spherical equivalent (SE) and AL were −0.44 ± 1.38 diopters (D) and 22.98 ± 0.87 mm, respectively. The prevalence of myopia (SE ≤ −0.75 D) and high myopia (SE ≤ −6.0 D/AL ≥ 26.0 mm) was 20.4 and 1.4/0.48%, respectively. Multiple regression analyses showed that myopia was not associated with lifestyle factors. The average illuminance in Aracati was about 100,000 lux from morning to evening. The current results reflect the ALs and the prevalence of myopia among Brazilian schoolchildren. There is a possibility that the light environment in addition to other confounding factors including racial differences affects the ALs and refractive errors.
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Affiliation(s)
- Erisa Yotsukura
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hidemasa Torii
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hiroko Ozawa
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
| | - Richard Yudi Hida
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
- Department of Ophthalmology, Universidade de Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 255-Cerqueira César, São Paulo SP 05402-000, Brazil;
- Department of Ophthalmology, Universidade Federal de Sao Paulo, R. Botucatu, 822-Vila Clementino, São Paulo SP 04039-032, Brazil
| | - Tetsuro Shiraishi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;
| | - Ivan Corso Teixeira
- Department of Ophthalmology, Santa Casa de Sao Paulo, Rua Dr. Cesario Mota Junior, 112-Vila Buarque, São Paulo SP 01221-010, Brazil; (I.C.T.); (C.F.M.d.N.)
| | | | - Caio Felipe Moraes do Nascimento
- Department of Ophthalmology, Santa Casa de Sao Paulo, Rua Dr. Cesario Mota Junior, 112-Vila Buarque, São Paulo SP 01221-010, Brazil; (I.C.T.); (C.F.M.d.N.)
| | - Kiwako Mori
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Miki Uchino
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
| | - Toshihide Kurihara
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Correspondence: (T.K.); (K.N.); (K.T.); Tel.: +81-3-5363-3204 (T.K.); +81-3-3353-1211 (K.N.); +81-3-3353-1211 (K.T.)
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
- Correspondence: (T.K.); (K.N.); (K.T.); Tel.: +81-3-5363-3204 (T.K.); +81-3-3353-1211 (K.N.); +81-3-3353-1211 (K.T.)
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; (E.Y.); (H.T.); (H.O.); (R.Y.H.); (K.M.); (M.U.)
- Tsubota Laboratory, Inc., 304 Toshin Shinanomachi-Ekimae Bldg., 34 Shinanomachi Shinjuku-ku, Tokyo 160-0016, Japan
- Correspondence: (T.K.); (K.N.); (K.T.); Tel.: +81-3-5363-3204 (T.K.); +81-3-3353-1211 (K.N.); +81-3-3353-1211 (K.T.)
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Heydarian S, Hashemi H, Jafarzadehpour E, Ostadi A, Yekta A, Aghamirsalim M, Dadbin N, Ostadimoghaddam H, Khoshhal F, Khabazkhoob M. Non-surgical Management Options of Intermittent Exotropia: A Literature Review. J Curr Ophthalmol 2020; 32:217-225. [PMID: 32775794 PMCID: PMC7382517 DOI: 10.4103/joco.joco_81_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 03/24/2020] [Accepted: 04/01/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose To review current non-surgical management methods of intermittent exotropia (IXT) which is one of the most common types of childhood-onset exotropia. Methods A search strategy was developed using a combination of the words IXT, divergence excess, non-surgical management, observation, overcorrecting minus lens therapy, patch/occlusion therapy, orthoptics/binocular vision therapy, and prism therapy to identify all articles in four electronic databases (PubMed, Web of Science, Google Scholar, and Scopus). To find more articles and to ensure that the databases were thoroughly searched, the reference lists of the selected articles were also reviewed from inception to June 2018 with no restrictions and filters. Results IXT is treated when binocular vision is impaired, or the patient is symptomatic. There are different surgical and non-surgical management strategies. Non-surgical treatment of IXT includes patch therapy, prism therapy, orthoptic sessions, and overcorrecting minus lens therapy. The objective of these treatments is to reduce the symptoms and the frequency of manifest deviation by decreasing the angle of deviation or enhancing the ability to control it. Conclusions Evidence of the efficacy of non-surgical management options for IXT is not compelling. More comprehensive randomized controlled trial studies are required to evaluate the effectiveness of these procedures and detect the most effective strategy.
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Affiliation(s)
- Samira Heydarian
- Department of Rehabilitation Sciences, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | | | - Amin Ostadi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Abbasali Yekta
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Nooshin Dadbin
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hashemi H, Pakzad R, Nabovati P, Azad Shahraki F, Ostadimoghaddam H, Aghamirsalim M, Pakbin M, Yekta A, Khoshhal F, Khabazkhoob M. The prevalence of tropia, phoria and their types in a student population in Iran. Strabismus 2019; 28:35-41. [DOI: 10.1080/09273972.2019.1697300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran
| | - Reza Pakzad
- Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences, Ilam
| | - Payam Nabovati
- Rehabilitation Research Center, Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran
| | - Fatemeh Azad Shahraki
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad
| | - Hadi Ostadimoghaddam
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad
| | | | - Mojgan Pakbin
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran
| | - Abbasali Yekta
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad
| | - Fahimeh Khoshhal
- Department of Pediatrics, Dezful University of Medical Sciences, Dezful
| | - Mehdi Khabazkhoob
- Department of Psychiatric Nursing and Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran
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Hashemi H, Pakzad R, Heydarian S, Yekta A, Aghamirsalim M, Shokrollahzadeh F, Khoshhal F, Pakbin M, Ramin S, Khabazkhoob M. Global and regional prevalence of strabismus: a comprehensive systematic review and meta-analysis. Strabismus 2019; 27:54-65. [PMID: 31012389 DOI: 10.1080/09273972.2019.1604773] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose: Despite the importance of information on the prevalence of strabismus, which can be effective in planning preventive and curative services, no study has addressed its prevalence comprehensively. In this study, a systematic search was done to estimate the regional and global prevalence of strabismus in different age and sex groups and factors affecting prevalence heterogeneity. Methods: A comprehensive and systematic search was done in different international databases, including Web of Science, Scopus, PubMed, Embase, etc. to find published articles on the total prevalence of strabismus and the prevalence of exotropia and esotropia. A binomial distribution was used to calculate the prevalence and 95% confidence interval (CI). The Cochran's Q-test and I2 were applied to evaluate heterogeneity and a random-effects model was used to assess the pooled prevalence. The Begg's test was administered to investigate publication bias and finally, a meta-regression method was applied to determine the factors affecting the heterogeneity among studies. Results: Of 7980 articles, 56 articles with a total sample size of 229,396 were analyzed. Many of these articles (n = 14) were from the Regional Office for the Americas. The estimated of pooled prevalence (95% CI) of any strabismus, exotropia, and esotropia was 1.93% (1.64-2.21), 1.23% (1.00-1.46), and 0.77% (0.59-0.95), respectively. The heterogeneity in prevalence of strabismus and its subtypes according to I2 was above 95% (p value <.001 for all). Age had a direct effect on heterogeneity in the prevalence of exotropia (b: 3.491; p: 0.002). Moreover, WHO region had a significant direct effect on heterogeneity in the prevalence of strabismus (b: 0.482; p < .001) and esotropia (b: 0.168; p: 0.027), and publication year had a significant direct effect on heterogeneity in the prevalence of exotropia (b: 0.059; p: 0.045). Sample size and publication year did not have any association with strabismus nor with other variables. There was no publication bias according to the Begg's test. Conclusion: The prevalence of strabismus varies widely in the world. As for factors affecting heterogeneity in the prevalence of strabismus, the results showed that age affected heterogeneity in the prevalence of exotropia, WHO region affected heterogeneity in the prevalence of strabismus and esotropia, and publication year affected heterogeneity in the prevalence of exotropia. Information about the global prevalence of strabismus can help health care planners design interventions and prioritize resource allocation.
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Affiliation(s)
- Hassan Hashemi
- a Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital , Tehran
| | - Reza Pakzad
- b Department of Epidemiology, Faculty of Health, Ilam University of Medical Sciences , Ilam
| | - Samira Heydarian
- c Department of rehabilitation science, School of Allied Medical Sciences, Mazandaran University of Medical Sciences , Sari
| | - Abbasali Yekta
- d Refractive Errors Research Center, Mashhad University of Medical Sciences , Mashhad
| | | | | | - Fahimeh Khoshhal
- f Department of Pediatrics, Dezful University of Medical Sciences , Dezful
| | - Mojgan Pakbin
- a Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital , Tehran
| | - Shahroukh Ramin
- g Department of Optometry, Shahid Beheshti University of Medical Sciences , Tehran
| | - Mehdi Khabazkhoob
- h Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences , Tehran
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