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S. A. Cotter, K. Tarczy-Hornoch, N. Liu, M. S. Borchert, M. Torres, S. P. Azen, R. Varma, MEPEDS Group; Factors Associated With Childhood Esotropia: The Multi-Ethnic Pediatric Eye Disease Study. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5712.
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To describe risk factors associated with esotropia in preschool children.
A population-based sample of African-American and Hispanic children aged 6-72 months underwent a comprehensive eye examination including cover testing and cycloplegic autorefraction (cyclopentolate 1%). Medical and perinatal histories were determined from a detailed parental questionnaire. Potential associations of esotropia with age, race/ethnicity, prematurity, birthweight, family history of strabismus and amblyopia, maternal age, breastfeeding, Down Syndrome, prenatal exposures to ethanol and tobacco, and refractive error type and magnitude were assessed. Candidate risk factors were identified using univariate analysis and significant factors were subsequently included in a multivariate logistic regression model. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were calculated.
Of the 6043 children studied, 60 had esotropia. Esotropia was significantly associated with decreased gestational age (OR=1.1; 95% CI, 1.1-1.2, per week decrease in gestational age), positive family history of strabismus (OR=2.8; 95% CI, 1.1-6.9), spherical equivalent (SE) anisometropia beginning at 1.00D-2.00D (OR=2.8; 95% CI, 1.2-6.6), and bilateral SE hyperopia ≥2.00D (OR ≥ 9.2 for all levels). Odds ratios increased with increasing hyperopia, ranging from 9.2 (95% CI, 3.4-24.5) for +2.00D-<+3.00D of hyperopia to 205 (95% CI, 65-649) for children with ≥+6.00D of hyperopia.
Our data suggest that even moderately low levels of bilateral hyperopia and anisometropia are associated with increased risk of esotropia. Future prospective studies on the incidence of esotropia in children with hyperopia/anisometropia and the impact of early optical correction of various levels of refractive error are needed. We were also able to confirm previous reports of associations between a higher prevalence of esotropia and decreased gestational age and family history of strabismus.
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