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Won Yeol Ryu, Ali Shariati, Scott R Lambert; Incidence of strabismus in children initially diagnosed with pseudostrabismus using the Optum® dataset. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4437. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Some children diagnosed with pseudostrabismus during early childhood are later found to have accommodative esotropia or intermittent exotropia. We used big data to determine the frequency with which children who were initially diagnosed with pseudostrabismus were later found to have strabismus.
This population-based retrospective cohort study used the Optum® SES medical claims dataset between 2003 and 2016. We included patients diagnosed with pseudostrabismus when ≤3 years of age. Patients diagnosed with strabismus before the diagnosis of pseudostrabismus or diagnosed simultaneously with strabismus and pseudostabismus were excluded. Age, gender, refractive error, and presence of amblyopia were assessed.
4,505,847,315 claims for 53,021,454 patients were analyzed. 22,052 children were diagnosed with pseudostrabismus below than 3 years. Strabismus was later diagnosed in 7% (1,518) of these children at a mean age of 3.7 ± 2.2 years. The most common types of strabismus diagnosed were esotropia (63.3%) and exotropia (28.7%). Amblyopia was present in 32.6% (495) of the patients who were later diagnosed with strabismus. 64.8% of the patients diagnosed with amblyopia had esotropia. The mean time interval between the diagnosis of pseudostrabismus and strabismus was 1.9 ± 2.0 (range; 0.01 – 13.75) years. A total of 327 children (21.5%) had strabismus surgery.
Accommodative esotropia can be misdiagnosed as pseudostrabismus during early childhood. A high percentage of children with accommodative esotropoia who were misdiagnosed with pseudostrabismus developed amblyopia presumably because there was more than a 2 year delay on average between the diagnosis of pseudostrabismus and strabismus. In addition, 21.5% of these children later underwent strabismus surgery. Young children should not be diagnosed with pseudostrabismus unless a cycloplegic refraction is performed to exclude moderate or high hyperopia.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Figure 1. Flow diagram for identifying the incidence of strabismus in children with pseudostrabismus
Figure 2. Time between diagnosis of pseudostrabismus and strabismus
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