Strabismus Success in Children of Lower Socioeconomic Backgrounds
Robert L. Dembinski; Megan E. Collins, MD; Courtney L. Kraus, MD
Johns Hopkins University
Introduction: Lower socioeconomic status (SES) is linked to higher rates of isolated strabismus.1 2 Little is known about short-and long-term outcomes following strabismus surgery. This study reports the surgical outcomes following horizontal strabismus surgery in patients of lower SES and identifies factors that may be associated with surgical success.
Methods: A retrospective review of children with medical assistance (MA) undergoing horizontal strabismus surgery between 2014-2017 was performed. MA was used as a proxy for lower SES. Children were included in analysis if they had data from preoperative, POM1, and POM6 visits. Pre- and postoperative ocular alignment, fusion, amblyopia, visual acuity, and stereopsis were recorded. Demographic information and compliance with treatment recommendations were recorded.
Results: 69/105 patients met eligibility criteria. Racial distribution was 41% Caucasian, 33% African American, 17% Hispanic, 4.5% Asian, 4.5% other. 56.6% were male. Mean surgical age was 6.22 years (10ms – 17yrs). Preoperatively, 45% patients were amblyopic, 61% were esotropes, 39% were exotropes. Success rate was 75.36% at POM6. 70.58% of failures were male. Failures had 20% higher rate of noncompliance with treatment.
Discussion: The overall success rate in our study population is comparable to that of other published accounts.3 However, the study population excluded 35 patients in data analysis due to poor post-operative follow-up. Theorizing poor appointment attendance may coincide with worse outcomes, eliminating these patients could bias our data set.
Conclusion: We found that race, gender, and compliance with treatment influenced surgical success rates in our population of pediatric strabismus patients with MA. Awareness of these factors can help encourage further research to identify at-risk patients and improve surgical success.
References: 1 Williams C, Northstone K, Howard M, Harvey I, Harrad RA, Sparrow JM. Prevalence and risk factors for common vision problems in children: data from the ALSPAC study. Br J Ophthalmol. 2008 Jul;92(7):959-64.
2 Pathai S, Cumberland PM, Rahi JS. Prevalence of and Early-Life Influences on Childhood Strabismus: Findings From the Millennium Cohort Study. Arch Pediatr Adolesc Med. 2010;164(3):250-257.
3 Leffler CT, Vaziri K, Schwartz SG, et al. Rates of Reoperation and Abnormal Binocularity Following Strabismus Surgery in Children. American journal of ophthalmology. 2016;162:159-166.