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Felicia C Adinanto, Amanda Nicole French, Kathryn Ailsa Rose; The prevalence of strabismus: A systematic literature review. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2457. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To determine if the prevalence of strabismus has altered over time due to improvements in the quality of maternal and neonatal health or whether it has remained stable throughout the 20th to 21st century.
A comprehensive search of the electronic database PubMed using the MeSH terms strabismus, additionally convergent and divergent, as well as terms such as squint, tropia, esotropia and exotropia was undertaken and in addition, hand searching of relevant journals, and journal articles and textbooks identifying relevant references published from 1900 to the present. All identified titles and abstracts (n = 960) were reviewed by two reviewers to select papers that met the criteria of the sample being population or school-based in order to establish prevalence over time (n = 75). In order to determine the prevalence of esotropia and exotropia, a further criteria of cover test by a qualified examiner as the gold standard to detect strabismus was used (n=30). Statistical analyses were done using SPSS.
Over the period 1920-2015, there was a statistically significant decline in the prevalence of strabismus (r = -0.33, p = 0.004) from 4.0% in 1920 to 3.2% in the 1980s which subsequently stabilised to an average of 2.9% (range: 0.8-5.8%) in 2010-2015. The mean prevalence of strabismus (2005-2015, 16 papers that used gold standard methods of detection) in European Caucasian and East Asian populations (3.1%, 3.3% respectively) was not significantly different (p=0.8). However, there was a significant difference in the type of strabismus present. In European Caucasian populations, 62.6% had esotropia as compared to only 17.7% in East Asian populations (p=0.001). Conversely, East Asian populations were predominantly exotropic (74.3%). No significant difference was found in the prevalence of strabismus between the ages 0-3, 3-8 and ≥9 years (p= 0.7) or between males/females in the 15 papers that reported this factor.
The data suggest an overall decline in the prevalence of strabismus over time, with a more recent stabilization. This may be linked to improvements in known risk factors for strabismus such as maternal health and postnatal infant care which is associated with esotropia and the consequences of low socio-economic status linked to exotropia.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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