Paper 10

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Strabismus and Strabismus Surgery in The United States: Analysis from the IRIS Registry

Michael X. Repka, MD, MBA;  Flora Lum, MD; Bhavya Burugapolli, MPH
Johns Hopkins University School of Medicine
Baltimore, Maryland

Introduction:  To describe the rates of strabismus, strabismus surgery, and strabismus surgery reoperations among all ages in the United States.

Methods:  Retrospective analysis of electronic health records from the IRIS® Registry (Intelligent Research in Sight) to identify unique patients with the diagnosis of strabismus and strabismus surgery from 2013 to 2016. The reoperation rate was calculated for first surgeries performed in 2013-2015.

Results:  29,445,231 unique patients were identified; 813,164 (2.76%) had a diagnosis of strabismus, 3.03% of males and 2.57% of females (difference=0.46 %, 95% CI:0.45 to 0.47, P < 0.0001). Strabismus surgery was performed in 39,262 (0.13%) patients. The rate of surgery ranged from 2.0% for children 0 to 5 years of age to <0.1% for adults older than 40 years of age. Horizontal surgery was most commonly performed in 35,093 patients, vertical surgery in 8,433, and superior oblique surgery in 619. Adjustable sutures were used in 2,873; 5,921(15.1%) were reoperations. Esotropia accounted for 30.7% and exotropia in 21.8% of cases. The rate of undergoing a second surgery within one year was 6.63%, lowest between 5-9 years of age (3.84%) increasing with age (p<0.001) to more than 10% for patients after 60 years of age.

Discussion:  Strabismus is an uncommon diagnosis. About 1 in 750 had strabismus surgery during a 4-year period; about 85% of those were first surgeries. Reoperations were performed for 1 in 15 cases, with an increase rate among older patients.

Conclusion:  ‘Big’ data from clinical data registries represent real world care that can be used to develop clinical benchmarks such as reoperation rate as well as identify areas suitable for practice improvement and for training program design.

References:  Friedman DA, Repka MX, Katz J, et al. Prevalence of Amblyopia and Strabismus in White and African-American Children Aged 6 through 71 Months: The Baltimore Pediatric Eye Disease Study. Ophthalmology 2009;116:2128-34.
Leffler CT, Vaziri K, Schwartz SG, et al. Rates of Reoperation and Abnormal Binocularity Following Strabismus Surgery in Children. Am J Ophthalmol 2016;162:159-66.
Leffler CT, Vaziri K, Cavuoto KM, et al. Strabismus Surgery Reoperation Rates With Adjustable and Conventional Sutures. Am J Ophthalmol 2015;160:385-90

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