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Jolyn Wei, Susan Cotter, Rohit Varma, Kristina Tarczy-Hornoch, Roberta McKean-Cowdin, James Tielsch, David Friedman, Michael Repka, Joanne Katz, Multi-ethnic Pediatric Eye Disease Study & Baltimore Pediatric Eye Disease Study Groups; Early Life Risk Factors Associated with Childhood Strabismus: The Multi-ethnic Pediatric Eye Disease Study and the Baltimore Pediatric Eye Disease Study. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6321.
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To investigate early life risk factors associated with esotropia or exotropia in infants and young children.
9970 children 6 to 72 months of age enrolled in two population-based cross-sectional studies in California and Maryland received comprehensive eye examinations and a parent underwent a detailed interview. Odds ratios (ORs) for various potential early life risk factors associated with esotropia or exotropia were determined using multivariate logistic regression analysis.
Esotropia was independently associated with older age, prematurity, maternal smoking during pregnancy, anisometropia, and hyperopia. There was a severity-dependent association of hyperopia with the prevalence of esotropia, with ORs increasing from 6.4 for 2.00 to <3.00 Diopters (D) of hyperopia to an OR of 122.0 for ≥5.00 D of hyperopia. Exotropia was associated with prematurity, maternal smoking during pregnancy, astigmatism (OR=2.5 for 1.50 to <2.50 D, and OR =5.9 for ≥2.5 D of astigmatism), and aniso-astigmatism in the J0 component (OR ≥2 for J0 aniso-astigmatism ≥0.25 D).
Prematurity and maternal smoking during pregnancy are associated with a higher risk of having both esotropia and exotropia. Refractive error is associated in a severity-dependent manner to the prevalence of esotropia and exotropia. Given that that refractive error is correctable, these risk associations should be considered when developing guidelines for the screening and management of refractive error in preschool children.
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