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Zhu H, You X, Jing Y, Chen Y, Jiang Y, Lin Y, Jiang T, Qin R, Lv H, Lu Q, Liu C, Xu X, Liu Y, Sun T, Jiang M, Xu B, Han X, Chen J, Jiang Y, Liu X, Zhou K, Jin G, Ma H, Hu Z, Liu H, Du J. Maternal Hypertensive Disorder in Pregnancy and Childhood Strabismus in Offspring. JAMA Netw Open 2024; 7:e2423946. [PMID: 39037813 PMCID: PMC11265127 DOI: 10.1001/jamanetworkopen.2024.23946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/26/2024] [Indexed: 07/24/2024] Open
Abstract
Importance Maternal hypertensive disorder in pregnancy (HDP) might affect ocular health in offspring; however, its association with strabismus remains unclear. Objective To examine the association of maternal HDP with overall and type-specific strabismus in offspring. Design, Setting, and Participants In the Jiangsu Birth Cohort study, a population-based study in China, pregnant women were recruited from April 24, 2014, to November 30, 2018. A total of 6195 offspring had maternal HDP diagnosis information, of whom 3078 were excluded due to having no information on ocular alignment or due to having ocular diseases other than strabismus or refractive error. Offspring underwent ocular examinations at 3 years of age, completed May 21, 2022. Data were analyzed from May 28, 2022, through December 15, 2023. Exposure Maternal HDP, categorized into hypertension and preeclampsia or with blood pressure (BP) well controlled (systolic BP, <130; diastolic BP, <80 mm Hg) and poorly controlled (systolic BP, ≥130; diastolic BP, ≥80 mm Hg). Main Outcomes and Measures The primary outcome was the incidence of strabismus in offspring. Poisson generalized linear mixed models were used to estimate the association between maternal HDP and strabismus. Results Among the included 3117 children (mean [SD] age, 36.30 [0.74] months; 1629 boys [52.3%]), 143 (4.6%) were exposed to maternal HDP and 368 (11.8%) had strabismus. Offspring exposed to maternal HDP had an 82% increased risk of overall strabismus (relative risk [RR], 1.82 [95% CI, 1.21-2.74]), an 82% increased risk of exophoria (RR, 1.82 [95% CI, 1.11-3.00]), and a 136% increased risk of intermittent exotropia (RR, 2.36 [95% CI, 1.13-4.93]) compared with unexposed offspring. When considering the type of maternal HDP, the risk for all strabismus was high for offspring exposed to preeclampsia (RR, 2.38 [95% CI, 1.39-4.09]) compared with unexposed offspring. When considering the BP control level of maternal HDP, the risk for all strabismus was high for offspring born to mothers with HDP and poorly controlled BP (RR, 2.07 [95% CI, 1.32-3.24]) compared with unexposed offspring. Conclusions and Relevance These findings suggest that maternal HDP is associated with an increased risk of offspring strabismus. Early screening of strabismus might be recommended for offspring with maternal HDP. Further exploration of the underlying mechanism of the association between HDP and strabismus is warranted.
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Affiliation(s)
- Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xue You
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yu Jing
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yiyuan Chen
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yangqian Jiang
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yuan Lin
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China
- State Key Laboratory of Reproductive Medicine (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Tao Jiang
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Rui Qin
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hong Lv
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- State Key Laboratory of Reproductive Medicine (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Qun Lu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Cong Liu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xin Xu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yuxin Liu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Tianyu Sun
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mengting Jiang
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Bo Xu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiumei Han
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jiaping Chen
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yue Jiang
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xiaoyu Liu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Kun Zhou
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Guangfu Jin
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- State Key Laboratory of Reproductive Medicine (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Hongxia Ma
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- State Key Laboratory of Reproductive Medicine (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Zhibin Hu
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- State Key Laboratory of Reproductive Medicine (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jiangbo Du
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- State Key Laboratory of Reproductive Medicine (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
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Arblaster G, Buckley D, Barnes S, Davis H. Strabismus Surgery for Psychosocial Reasons-A Literature Review. Br Ir Orthopt J 2024; 20:107-132. [PMID: 38681188 PMCID: PMC11049605 DOI: 10.22599/bioj.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/04/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Strabismus surgery may be undertaken for visual benefit, to improve or eliminate diplopia symptoms, or to restore or improve binocular single vision (BSV). In patients without visual symptoms or expected visual benefit, strabismus surgery may still be undertaken if the presence of strabismus causes the patient psychosocial symptoms. To evaluate strabismus surgery undertaken for psychosocial reasons, evidence of postoperative outcomes in this specific cohort is needed. Methods A systematic search of the literature was conducted (1946-2023) to identify evidence where postoperative outcomes were reported for adult patients (age 18 years and above) who had undergone strabismus surgery for psychosocial reasons. Results Sixty-nine papers were included in the literature review. Most sources of evidence included patients within heterogeneous cohorts of strabismus surgery outcomes, with a range of symptoms and differing surgical aims. Discussion In adults who underwent strabismus surgery for psychosocial reasons, improved postoperative ocular alignment and/or improved health related quality of life (HRQoL) were common. Strabismus surgery outcomes appeared to be measured satisfactorily at three months postoperatively. Additional surgical outcomes, including an expanded field of vision, unexpected BSV, improved binocular summation, improved task performance and improved eye movements have been reported, but not fully investigated. There was a lack of consensus on how postoperative success should be defined and measured. A core outcome set for strabismus has been suggested and there is potential to add to the available evidence by investigating which outcome measures are most relevant to those with strabismus and psychosocial symptoms. There is a growing need for robust evidence in this specific subgroup of patients due to a lack of evidence specifically reporting postoperative outcomes in adults with strabismus and psychosocial symptoms.
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Affiliation(s)
- Gemma Arblaster
- Division of Ophthalmology and Orthoptics, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, UK
- Orthoptic Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - David Buckley
- Division of Ophthalmology and Orthoptics, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, UK
| | - Sarah Barnes
- School of Medicine and Population Health, University of Sheffield, UK
| | - Helen Davis
- Division of Ophthalmology and Orthoptics, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, UK
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Benhaim-Sitbon L, Lev M, Polat U. Abnormal basic visual processing functions in binocular fusion disorders. Sci Rep 2023; 13:19301. [PMID: 37935803 PMCID: PMC10630403 DOI: 10.1038/s41598-023-46291-w] [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: 04/24/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023] Open
Abstract
Heterophoria is a common type of binocular fusion disorder that consists of a latent eye misalignment with potential consequences on daily activities such as reading or working on a computer (with CVS). Crowding, a type of contextual modulation, can also impair reading. Our recent studies found an abnormal pattern of low-level visual processing with larger perceptive fields (PF) in heterophoria. The PF is the fundamental processing unit of human vision and both masking and crowding depend on its size. We investigated how heterophoria would impact the PF's size via a lateral masking experiment and consequently affect the foveal crowding at different letter-spacings (the crowding zone). More specifically, we explored the relationship between crowding, lateral masking, the PF's size, and the amount of heterophoria. The binocular horizontal PF's size was larger with heterophoric subjects, in agreement with our previous study. We found a stronger crowding and an extended crowding zone associated with slower response times; this shows that the processing of letter identification under both crowded and uncrowded conditions requires more processing effort in heterophoric individuals. In agreement with previous studies, we found a correlation between the crowding zone and the PF's size; each was strongly correlated with the amount of phoria. These findings resemble those involving the PF size and the extended crowding found at the fovea in amblyopia and young children. We suggest that these findings could help explain the inter-observers' variability found in the masking literature, and the reading difficulties often encountered in subjects with high heterophoria.
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Affiliation(s)
- Laura Benhaim-Sitbon
- School of Optometry and Vision Sciences, Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Maria Lev
- School of Optometry and Vision Sciences, Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Uri Polat
- School of Optometry and Vision Sciences, Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel.
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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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Benhaim-Sitbon L, Lev M, Polat U. Extended perceptive field revealed in humans with binocular fusion disorders. Sci Rep 2023; 13:6584. [PMID: 37085571 PMCID: PMC10121568 DOI: 10.1038/s41598-023-33429-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023] Open
Abstract
Binocular vision disorders or dysfunctions have considerable impact on daily visual activities such as reading. Heterophoria (phoria) is a latent eye misalignment (with a prevalence of up to 35%) that appears in conditions that disrupt binocular vision and it may affect the quality of binocular fusion. Our recent study, which used lateral masking (LM), suggests that subjects with binocular fusion disorders (horizontal phoria) exhibit an asymmetry and an abnormal pattern of both binocular and monocular lateral interactions, but only for the horizontal meridian (HM). The perceptive field (PF) is the fundamental processing unit of human vision and both masking and crowding depend on its size. An increased PF size is found in amblyopic populations or in young children. We hypothesized that the PF's size would be asymmetric only for the phoric group (larger along the HM). We estimated the PF's size using two different methods (LM with equal-phase and opposite-phase flankers). Phoric subjects exhibited a larger binocular PF size, only for the HM, confirming our hypothesis of an asymmetric PF size. However, the monocular PF size of phoric and control subjects was similar. Phoria affects the PF's size similarly to meridional amblyopia but without being attributed to abnormal refraction. We suggest that these findings could help explain the inter-observer variability found in the masking literature and the reading difficulties often encountered in subjects with high heterophoria. Since perceptual learning can reduce the PF's size, further investigation of training may provide a novel therapy to reduce some symptoms related to heterophoria.
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Affiliation(s)
- Laura Benhaim-Sitbon
- School of Optometry and Vision Sciences, Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Maria Lev
- School of Optometry and Vision Sciences, Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Uri Polat
- School of Optometry and Vision Sciences, Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel.
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Binocular fusion disorders impair basic visual processing. Sci Rep 2022; 12:12564. [PMID: 35869104 PMCID: PMC9307628 DOI: 10.1038/s41598-022-16458-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
In an era of increasing screen consumption, the requirement for binocular vision is demanding, leading to the emergence of syndromes such as the computer vision syndrome (CVS) or visual discomfort reported by virtual reality (VR) users. Heterophoria (phoria) is a latent eye misalignment (with a prevalence up to 35%) that appears in conditions that disrupt binocular vision and may affect the quality of binocular fusion. Collinear facilitation (CF), the mechanism for grouping contour elements, is a process that reveals lateral interactions by improving the visibility of a target by flankers placed collinearly. An abnormal pattern of CF has been observed in strabismic amblyopia. We hypothesize that phoria may affect CF in the horizontal meridian (HM) due to latent eye misalignment and its impact on binocular fusion. Fully corrected participants (phoria group and controls) completed a standard CF experiment for horizontal and vertical meridians during binocular and monocular viewing. Phoric observers exhibited (1) an asymmetry and an abnormal pattern of CF only for the HM, during both monocular and binocular viewing, (2) poor binocular summation between the monocular inputs, and (3) no binocular advantage of the CF. Phoria affects the CF in a way that is reminiscent of meridional amblyopia without being attributed to abnormal refraction. The abnormal pattern of CF in monocular viewing suggests that phoria could be a binocular developmental disorder that affects monocular spatial interactions. We suggest that the results could contribute to explain the visual discomfort experienced with VR users or symptoms when presenting CVS.
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Yang L, Min Y, Jia Z, Wang Y, Zhang R, Sun B. Medical expenditure for strabismus: a hospital-based retrospective survey. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:27. [PMID: 35752832 PMCID: PMC9233768 DOI: 10.1186/s12962-022-00363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background and aims The misconception of the purpose of strabismus treatment has, on the one hand, affected the motivation of strabismus patients to seek care and, on the other hand, has resulted in strabismus not being covered by health insurance, both of which interact to limit the motivation of strabismus patients and also impose a financial burden on strabismus patients. Previous studies on the cost of strabismus had only addressed the cost utility and functional and psychosocial benefits of strabismus surgery. The aim of this study was to estimate the direct medical expenditure incurred for strabismus surgery and analyze the trend for the period 2014–2019 using the data collected by local eye hospitals in northeast China. Methods This study was based on 6-year strabismus medical expenditure data collected from the eye hospital of the first affiliated hospital of Harbin medical university, covering 3596 strabismus patients who had strabismus surgery. All medical expenditure data were adjusted to 2014 using China’s annual consumer price index to remove the effects of inflation. Results The average direct medical expenditure for strabismus cares (in 2014) was 5309.6 CNY (US$870.4), and the annual growth rates from 2015 to 2019 (compared with the previous year) were 9.3, 7.7, 21.7, 14.5, and 4.3%, respectively. Surgical expenses accounted for the highest proportion (33.1%) of the total medical expenses followed by examinations expenses (19.7%) and medical consumables expenses (18.7%). The regression coefficient for general anaesthesia was 1804.5 and age was less than 0. Conclusion The average direct medical expenditure for strabismus increases year by year, and the growth rate is rapid. Anesthesia was the most important factor increasing medical cost, and age was negatively correlated with cost.
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Affiliation(s)
- Lei Yang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yiduo Min
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhiyan Jia
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
| | - Yupeng Wang
- Department of Biostatistics, Harbin Medical University, Harbin, Heilongjiang, China
| | - Rihui Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Bitong Sun
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Commonly occurring genetic polymorphisms with a major impact on the risk of nonsyndromic strabismus: replication in a sample from Finland. J AAPOS 2022; 26:12.e1-12.e6. [PMID: 34856371 DOI: 10.1016/j.jaapos.2021.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE To replicate associations between polymorphisms in the WRB and TSPAN10 genes and strabismus in an independent Finnish cohort and to calculate their population attributable risk. METHODS Polymorphisms in the WRB (rs2244352) and TSPAN10 (rs6420484) genes were investigated in individuals from the FinnGen study group who had one of three categories of strabismus, with clinical diagnoses of (1) "strabismus-all subtypes" (3,515 cases and 173,384 controls), (2) "convergent concomitant strabismus" (ICD-10 code H50.0; 737 cases and 170,976 controls), and (3) "divergent concomitant strabismus" (ICD-10 code H50.1; 1,059 cases and 170,976 controls). RESULTS The WRB polymorphism was associated with "all subtypes" of strabismus (OR = 1.08; P = 0.008) and divergent strabismus (OR = 1.11; P = 0.046) but not with convergent strabismus (P = 0.41). The WRB polymorphism had a population attributable risk of 3.4% for all strabismus subtypes and 4.7% for divergent strabismus. The TSPAN10 polymorphism was associated with all three strabismus phenotypes: "all subtypes" (OR = 1.08; P = 0.002), convergent strabismus (OR = 1.19; P = 0.001) and divergent strabismus (OR = 1.20; P =7.21E-05). The population attributable risk for the TSPAN10 polymorphism was 6.0% for any strabismus, 13.3% for convergent strabismus, and 13.9% for divergent strabismus. CONCLUSIONS Genetic association with strabismus was replicated in a Finnish cohort for two common polymorphisms. Under the assumption that these polymorphisms are independent of other risk factors, they are responsible for up to 20% of isolated cases of strabismus in Finland, similar to estimates in other European populations.
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Hashemi H, Nabovati P, Yekta AA, Agha Mirsalim M, Rafati S, Ostadimoghaddam H, Khabazkhoob M. Binocular vision disorders in a geriatric population. Clin Exp Optom 2021; 105:539-545. [PMID: 34016028 DOI: 10.1080/08164622.2021.1922065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Clinical relevance: A population-based epidemiological survey is important to help establish the frequency of binocular vision disorders in a geriatric population. Such data will be useful to clinicians and help guide diagnostic testing for this age group.Background: To determine the prevalence of binocular vision disorders and their associations with age and sex in the geriatric population.Methods: This report is a part of the Tehran Geriatric Eye study (TGES); a population-based cross-sectional study conducted on residents over 60 years of age in Tehran, Iran, using random stratified cluster sampling. A total of 165 clusters were selected (proportionally to size) from 22 strata of Tehran city. All participants underwent a complete ocular examination including the measurement of visual acuity, refraction, unilateral and alternating cover tests, and the Worth 4-dot suppression test. Strabismus was defined as the presence of constant unilateral or alternating esotropia or exotropia at either near (40 cm) or far (6 m). Distance and near exophoria were defined as more than 3Δ and 9Δ of exophoria at 6 m and 40 cm, respectively. Distance and near esophoria were defined as more than 1Δ and any amount of esophoria at 6 m and 40 cm, respectively.Results: Statistical analysis was performed on the data of 2,227 participants. The mean age of the participants was 66.6 ± 5.4 years and 59.4% were female. The prevalence of distance exophoria, esophoria, and hyperphoria was 8.9%, 0.34%, and 0.29%, respectively. The prevalence of near exophoria, esophoria, and hyperphoria was 32.4%, 0.61%, and 0.37%, respectively. The prevalence of distance exotropia and esotropia was 1.3% and 0.63%, respectively. The prevalence of near exotropia and esotropia was 4.6% and 0.59%, respectively.Conclusion: Non-strabismic binocular vision disorders were prevalent in an elderly population. Exo deviations were more prevalent than eso deviations.
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Affiliation(s)
- Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Payam Nabovati
- Rehabilitation Research Center, Department of Optometry, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Ali Yekta
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran.,Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shokoofeh Rafati
- Rehabilitation Research Center, Department of Optometry, Iran University of Medical Sciences, 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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Agaje BG, Delelegne D, Abera E, Desta K, Girum M, Mossie M, Eshetu D, Hirigo AT. Strabismus prevalence and associated factors among pediatric patients in southern Ethiopia: a cross-sectional study. J Int Med Res 2021; 48:300060520964339. [PMID: 33076734 PMCID: PMC7583393 DOI: 10.1177/0300060520964339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Objective To assess the strabismus prevalence and associated factors among children
aged ≤15 years. Methods This hospital-based cross-sectional study was conducted from March 2017 to
October 2017 in the Department of Ophthalmology & Optometry, Hawassa
University Comprehensive Specialized Hospital. Interviewer-administered
questionnaires were used to collect relevant data and clinical examinations
were performed for patient diagnosis. Results Overall, 582 children participated in the study (response rate, 97%). The
prevalence of childhood strabismus was 17.9% [95% confidence interval:
14.6–21.1]. Additionally, 9.6%, 16.7%, and 9.6% of the children had
anisometropia, amblyopia, and dense cataract, respectively. Among the 16.7%
of children with amblyopia, 56.7% had strabismus; among the 22.5% of
children with clinically significant refractive error, 52.7% had strabismus.
Moreover, among the 9.6% of children with anisometropia, 58.9% had
strabismus. The presence of amblyopia (adjusted odds ratio [95% confidence
interval]: 3.9, 1.7–8.6), age <5 years (13.5 [5.0–36.1]), age 5 to 10
years (6.1 [2.3–16.3]), and clinically significant refractive error (13.3
[5.8–30.6]) were significantly associated with childhood strabismus. Conclusions The prevalence of strabismus was relatively high among patients in this
study. Early screening for childhood strabismus is essential. A
well-controlled community-based study is needed to confirm strabismus
prevalence and predictors.
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Affiliation(s)
- Bekalu Getahun Agaje
- Department of Ophthalmology & Optometry, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Demoze Delelegne
- Department of Ophthalmology & Optometry, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Elias Abera
- Department of Ophthalmology & Optometry, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Kindie Desta
- Department of Ophthalmology & Optometry, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Mikael Girum
- Department of Ophthalmology & Optometry, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Mulat Mossie
- Department of Anesthesiology & Anesthesia, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
| | - Daniel Eshetu
- Department of Microbiology, Yirgalem Hospital Medical College, Yirgalem, Ethiopia
| | - Agete Tadewos Hirigo
- School of Medical Laboratory Sciences, College of Medicine and Health Science, Hawassa University, Hawassa, Ethiopia
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Mon-López D, Bernardez-Vilaboa R, Sillero-Quintana M, Fernandez-Balbuena AA. Air shooting competition effects on visual skills depending on the sport level. Eur J Sport Sci 2021; 22:336-343. [PMID: 33427595 DOI: 10.1080/17461391.2021.1874540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Olympic shooting is a sport with high demands of accuracy. Minimal visual errors could be related to performance losses. However, not all visual skills have been studied in depth in this sport. The main objectives of this study were to compare differences in shooters' visual skills by level and to analyze the competition effect on them. Sixty-six participants were distributed in three groups (non-athletes, elite and non-elite). Eleven visual variables were tested in four skills groups (visual acuity, heterophoria, accommodation functions and other visual skills). The data were collected through a pre- and post-competition simulation test. The results of the study showed differences between groups by shooting sport level. In general, shooters had higher visual acuity values than non-athletes p < .001 with large size effects (d between 1.01 and 2.35), and elite shooters presented higher values of accommodation than non-elite shooters p < .05 with large size effects (d between 0.88 and 0.97). Furthermore, different visual skills were modified after competition depending on the shooting level. Specifically, visual accommodation skills were only improved in elite shooters. Finally, our study suggests that elite shooters employ different visual strategies or skills to non-elite shooters and that shooting activity is closely related to some specific visual skills. This aspect should be considered by coaches in the design of optimal visual trainings and improve the shooters' performance.Highlights Shooters showed better acuity skills than non-athletes.Shooting activity seems to improve visual acuity skills, binocular visual time and eye-hand coordination in non-elite shooters, and accommodation and eye-hand coordination in elite shooters immediately after the competition simulation.Elite shooters employ different visual strategies or skills to non-elite shooters.Non-dominant eye occlusion may benefit binocular vision recovery by inhibiting aiming action and the use of accommodative flexibility could be related to the QE during the shot.
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Affiliation(s)
- Daniel Mon-López
- Departamento de Deportes de la Facultad de Ciencias de la Actividad Física y del Deporte-INEF de la Universidad Politécnica de Madrid Madrid, Spain
| | - Ricardo Bernardez-Vilaboa
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Sillero-Quintana
- Departamento de Deportes de la Facultad de Ciencias de la Actividad Física y del Deporte-INEF de la Universidad Politécnica de Madrid Madrid, Spain
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Su H, Fu J, Chen W, Meng Z, Li L, Dai W, Yao Y. Prevalence of Heterophoria in Tibetan Grade-One Students: The Lhasa Childhood Eye Study. J Ophthalmol 2020; 2020:9570908. [PMID: 33489351 PMCID: PMC7803105 DOI: 10.1155/2020/9570908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 11/14/2020] [Accepted: 12/11/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION The study aims to explore the prevalence of heterophoria and associate factors in Tibetan grade-one students. METHODS The Lhasa Childhood Eye Study (LCES) is a school-based cohort study. 1942 grade-one students from 7 elementary schools were randomly sampled by stratified cluster sampling. Ocular examinations were performed in participants, including ocular motility, distance and near visual acuity, cycloplegic autorefraction, and stereoacuity. The near (33 cm) and distance (6 m) fixation cover test was used to differentiate orthophoria, heterophoria, and heterotropia, and the magnitude of the phoria was measured by the Maddox rod and prisma. RESULTS Of 1856 grade-one students completing all the ocular examinations, 1852 participants finished the ocular alignment test. The mean age was 6.82 ± 0.46 years (range 6∼10 years); 981 (52.97%) were males, and 871 (47.03%) were females. The prevalence of phoria was 22.89% (n = 424). At distance fixation, the prevalence of heterophoria, exophoria, and esophoria was 4.64%, 4.21%, and 0.43% separately, while at near fixation, the prevalence was 22.73%, 22.35%, and 0.38%. No vertical phoria was detected. The mean magnitude of heterophoria at near and distance fixation was -7.63 ± 5.15 PD (exo: -7.83 ± 4.91 PD, eso: +5.67 ± 3.61 PD) and -4.84 ± 5.94 PD (exo: -6.26 ± 4.20 PD, eso: +8.13 ± 3.04 PD). The prevalence of esophoria was associated with hyperopia (OR = 6.38, 95% CI: 1.15-35.28, P = 0.03; OR = 5.42, 95% CI: 1.04-28.24, P = 0.04) and amblyopia (OR = 16.02, 95% CI: 1.81∼141.96, P = 0.01; OR = 11.37, 95% CI: 1.34∼96.52, P = 0.03) at near and distance fixation. The prevalence of exophoria was associated with myopia at near fixation (OR = 2.43, 95% CI: 1.47-4.00, P<0.01). In the near heterophoria group, the proportion of children with abnormal stereoacuity was 23.26% (n = 97), significantly higher (χ 2 = 5.70, P = 0.017) than that in orthophoria (17.99%, n = 244). CONCLUSIONS In Lhasa, grade-one pupils have a lower prevalence of heterophoria. Near exophoria was associated with myopia, while esophoria was related to hyperopia and amblyopia both near and distance. Heterophoria may be one of the affected factors for reducing stereoacuity.
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Affiliation(s)
- Han Su
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Weiwei Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
- Beijing Institute of Ophthalmology, Beijing, China
| | - Zhaojun Meng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Lei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Wei Dai
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Yao Yao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
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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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Prevalence of Strabismus and Its Impact on Vision-Related Quality of Life. Ophthalmology 2020; 127:1113-1122. [DOI: 10.1016/j.ophtha.2020.02.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/23/2019] [Accepted: 02/20/2020] [Indexed: 12/20/2022] Open
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Burgos-Blasco B, Hernández-García E, Morales Fernández L, Gómez-de-Liaño R. Satisfaction with strabismus surgery based on the opinion of expert surgeons. ACTA ACUST UNITED AC 2020; 96:19-25. [PMID: 32709474 DOI: 10.1016/j.oftal.2020.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the perception of strabismus surgeons in Spain regarding patient satisfaction after surgery, by analysing the types of strabismus with the most satisfied patients, as well as the causes of dissatisfaction. METHODS A survey was carried out among the members of the Spanish Strabology Society who were over 50 years of age, active in Spain, with more than 20 years of surgical experience, and whose main surgical activity was strabismus. The questionnaire consisted of 18 questions about the perception of patient satisfaction according to the type of strabismus, patient age, as well as the most frequent cause of dissatisfaction after surgery. RESULTS The questionnaires were completed by a total of 29 surgeons, with a mean of 31 years of surgical experience. The most frequent cause of perceived dissatisfaction was residual strabismus. No differences were found in the satisfaction index between children and adults. The surgery that was considered to produce greater satisfaction was endotropia, followed by decompensated 4th nerve palsy, and exotropia, while 3rd nerve palsy was the cause of the most dissatisfaction. CONCLUSIONS According to strabismus surgeons, endotropia is the most satisfactory surgery for the patient, followed by exotropia, vertical strabismus, and traumatic paralysis of the 4th cranial nerve.
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Affiliation(s)
- B Burgos-Blasco
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.
| | - E Hernández-García
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - L Morales Fernández
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - R Gómez-de-Liaño
- Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
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The Prevalence of Ptosis and Nystagmus in Rural Population. J Curr Ophthalmol 2020; 32:178-182. [PMID: 32671302 PMCID: PMC7337018 DOI: 10.1016/j.joco.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine the prevalence of ptosis and nystagmus in the general rural population in Iran. Methods Two villages were selected from the north and southwest of Iran using a multi-stage cluster sampling approach. After selection of the participants and inviting them to a complete eye exam, they all had vision tests and an ophthalmic examination. Vision tests included measurement of visual acuity, refraction, and the cover test. Then the slit-lamp exam was performed, and the diagnosis of ptosis and nystagmus was determined by an ophthalmologist. Results Of the 3851 invitees, 3314 people participated in the study. The prevalence of ptosis in this study was 2.23% [95% confidence interval (CI): 1.73-2.74], and 45.3% of the cases were bilateral ptosis. The prevalence of ptosis was lowest in the 21-30 year (0.2%) and the under 5 year (0.8%) age groups, and the highest prevalence was observed in people over 70 years of age (6.7%) (P < 0.001). The prevalence of ptosis was higher in illiterate people than those with an academic education level (P = 0.012). The prevalence of astigmatism was 62.8% in those with ptosis and 34.2% in those without ptosis (P < 0.001). The prevalence of nystagmus was 0.39% (13 cases). Conclusions This study found that the prevalence of ptosis is relatively high in the general rural population in Iran, and the prevalence increases with age. Astigmatism is significantly high among cases with ptosis, and its prevalence has an inverse relation with the level of education. Nystagmus also had a high prevalence in this population.
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Hong J, Fu J, Wang YD, Zhao BW, Li L. Prevalence of heterophoria in a population of school children in central China: the Anyang Childhood Eye Study. Int J Ophthalmol 2020; 13:801-805. [PMID: 32420229 DOI: 10.18240/ijo.2020.05.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 03/14/2020] [Indexed: 12/16/2022] Open
Abstract
AIM To investigate the prevalence of heterophoria and the relationship between heterophoria and refractive error in a school-based study conducted in central China. METHODS A total of 2363 7th-grade children were recruited into the cross-sectional school-based Anyang Childhood Eye Study (ACES) by cluster sampling method. Heterophoria was examined using alternate cover and cover-uncover testing. The Maddox rod and prism test were conducted at 33 cm and 6 m distance fixation. Uncorrected viual acuity (UCVA) and best-corrected viual acuity (BCVA) were recorded as logarithm of the minimum angle of resolution (logMAR) with cycloplegic autorefraction by administrating of Mydrin-P and 1.0% cyclopentolate. Hyperopia was defined as the spherical equivalent (SE) refraction of +0.50 D or greater, and higher hyperopia was defined as +2.00 D or greater. Emmetropia was defined as the SE refraction in the range of -0.49 to +0.49 D, and myopia was in the SE refraction range from -0.50 D to less. RESULTS Totally 2260 students in grade 7 were examined. Response rate among eligible children was 95.64%. Totally 486 children, 22.66% of the population, were diagnosed with heterophoria in which 479 were diagnosed with exophoria at near distance, and 6 with esophoria. Totally 89 (4.15%) children were diagnosed with heterophoria in which 82 had exophoria, and 7 had esophoria at far distance. Exophoria was common at near fixation (22.33%). Myopia was examined to be related to exophoria at near distance (OR 3.03, 95%CI 2.33-3.95) and far distance fixation (OR 1.90, 95%CI 1.09-3.32). CONCLUSION Exophoria is a predominant heterophoria for 7th-grade junior school in central China. Significant associations are discovered between heterophoria and refractive error. Hyperopia is associated with esophoria, and myopia is associated with exophoria.
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Affiliation(s)
- Jie Hong
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Science Key Laboratory, Beijing 100730, China
| | - Jing Fu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Science Key Laboratory, Beijing 100730, China
| | - Yi-Di Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Science Key Laboratory, Beijing 100730, China
| | - Bo-Wen Zhao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Science Key Laboratory, Beijing 100730, China
| | - Lei Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology and Visual Science Key Laboratory, Beijing 100730, China
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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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Makateb A, Hashemi H, Farahi A, Mehravaran S, Khabazkhoob M, Asgari S. Ocular alignment, media, and eyelid disorders in Down syndrome. Strabismus 2019; 28:42-48. [PMID: 31830843 DOI: 10.1080/09273972.2019.1699582] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Determining the age and gender distribution of ocular disorders in Down syndrome patients aged 10 to 30 years.Methods: In this study, 226 of 250 invited patients through special needs schools, the National Down Syndrome Society, and relevant nonprofit organizations were included. In Noor Eye Hospital, the patients underwent a complete eye examination by a general ophthalmologist and suspect cases were reexamined by a sub-specialist. Examinations included ocular alignment, conjunctiva, eyelid, lacrimal system, cornea, iris, and lens assessment.Results: Mean age of participants was 16.05 ± 4.82 years and 53.0% were male. The most common ocular abnormalities were blepharitis (81.9%, 95% CI:78.0 to 85.3), lens opacity (37.8%, 95% CI:33.3 to 42.3), strabismus (23.4%, 95% CI:19.5 to 27.4; 21.2% esotropia, 0.9% exotropia, and 1.8% dissociated vertical deviation), floppy eyelid (19.9%, 95% CI:16.3 to 23.9), posterior embryotoxon (17.7%, 95% CI:14.2 to 21.2) and nystagmus (11.7%, 95% CI:8.9 to 15.0). Based on independent sample t test, the prevalence of nystagmus (P = .041) and congenital lens opacity (P<0.001) significantly increased with age. There was no significant inter-gender difference in the prevalence of any of the studied disorders by chi-square test.Conclusion: In young patients with Down syndrome, the prevalence of ocular pathologies appears to be high and increase with aging. It can be resulted from the cumulative prevalence of undiagnosed or untreated cases. Findings of the study can be a reliable reference for health policy in terms of screening for eye disease and addressing eye care needs.
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Affiliation(s)
- Ali Makateb
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran
| | - Azadeh Farahi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran
| | - Shiva Mehravaran
- ASCEND Center for Biomedical Research, Morgan State University, Baltimore, MD
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran
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Hultman O, Beth Høeg T, Munch IC, Ellervik C, la Cour M, Andersson Grönlund M, Buch Hesgaard H. The Danish Rural Eye Study: prevalence of strabismus among 3785 Danish adults - a population-based cross-sectional study. Acta Ophthalmol 2019; 97:784-792. [PMID: 31025814 DOI: 10.1111/aos.14112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 03/19/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To determine the prevalence of strabismus among Danish adults and to find the frequency of history of strabismus and strabismus surgery. Furthermore, to evaluate the prevalence of strabismus-associated amblyopia among participants with strabismus and to relate the results to the current national vision screening programme. METHODS In total, 3785 adults in the Danish Rural Eye Study underwent an interview regarding eye health, visual acuity measurement, Hirschberg test and retinal photography. Participants were categorized into groups based on their birth date in relation to the introduction of the national vision screening programme. RESULTS In total, the prevalence of strabismus was 1.1% (41/3785; 95% CI: 0.8-1.5); no differences were found in relation to gender or screening status. The prevalence of exotropia (XT) was 0.3% (12/3785; 95% CI: 0.2-0.6) and of esotropia (ET) 0.8% (29/3785; 95% CI: 0.5-1.1), resulting in an XT:ET ratio of 1:2.7. A history of strabismus was present in 4.6% (174/3785; 95% CI: 4.0-5.3), and a history of strabismus surgery was present in 0.8% (32/3785; 95% CI: 0.6-1.2) of the participants. Among participants with manifest strabismus, 24% had strabismus-associated amblyopia. CONCLUSION In this first European population-based study of strabismus prevalence in adults, the prevalence was similar to three out of five previous studies using cover test. The use of Hirschberg test may have led to an underestimation of the true prevalence. The prevalence was neither related to screening status nor gender. Our results are the first to display a predominance of ET among Caucasian Scandinavian adults.
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Affiliation(s)
- Oscar Hultman
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
| | - Tracy Beth Høeg
- Department of Physical Medicine & Rehabilitation School of Medicine University of California‐Davis Sacramento California USA
| | - Inger Christine Munch
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Christina Ellervik
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
- Department of Production, Research, and Innovation Region Zealand Sorø Denmark
- Department of Laboratory Medicine Boston Children's Hospital Harvard Medical School Boston Massachusetts USA
| | - Morten la Cour
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
- Department of Ophthalmology Rigshospitalet Copenhagen Denmark
| | - Marita Andersson Grönlund
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Department of Ophthalmology Sahlgrenska University Hospital Mölndal Sweden
| | - Helena Buch Hesgaard
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
- Department of Ophthalmology Sahlgrenska University Hospital Mölndal Sweden
- Copenhagen Eye & Strabismus Clinic Capio‐CFR Hospitals Copenhagen Denmark
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Wang J, Ding G, Li Y, Hua N, Wei N, Qi X, Ning Y, Zhang Y, Li X, Li J, Song L, Qian X. Refractive Status and Amblyopia Risk Factors in Chinese Children with Autism Spectrum Disorder. J Autism Dev Disord 2019; 48:1530-1536. [PMID: 29170942 DOI: 10.1007/s10803-017-3387-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Amblyopia risk factors in children with autism spectrum disorders (ASD) are usually hard to detect in early childhood due to poor cooperation and has not been reported in the Chinese population. We screened 168 Chinese children with ASD, aged between 3 and 8 years, and 264 age-matched neurotypical children with Spot photoscreener and basic ophthalmologic examinations. Children with ASD were found to have normal refractive status but significantly higher incidence of strabismus (16.1%), compared with control children (1.5%) (p < 0.01). Most of the cases of strabismus found in children with ASD were classified as esodeviation. Strabismus in children with ASD should be considered more seriously as an amblyopia risk factor by ophthalmologists and other healthcare professionals.
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Affiliation(s)
- Jiaxing Wang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China.,Department of Ophthalmology, Emory University, Atlanta, GA, USA
| | - Gang Ding
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Ying Li
- Department of Ophthalmology, Emory University, Atlanta, GA, USA
| | - Ning Hua
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Nan Wei
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Xiaoli Qi
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Yuxian Ning
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Ying Zhang
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Xue Li
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Jing Li
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Linlin Song
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China
| | - Xuehan Qian
- Department of Strabismus and Pediatric Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, 300384, China.
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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: 96] [Impact Index Per Article: 19.2] [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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