Abstract
Purpose :
Timely strabismus diagnosis may improve amblyopia outcomes or prevent need for surgery. We assessed factors associated with delayed diagnoses and worse outcomes in pediatric strabismus.
Methods :
We analyzed electronic health record data from the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight), including children ≤10 years with exotropia or esotropia diagnosis codes. Primary outcome was age at strabismus diagnosis. Associations between strabismus surgery or residual amblyopia and race/ethnicity, insurance, population density, and access to pediatric ophthalmology were analyzed using multivariable linear, logistic regression, and survival analysis.
Results :
Of 161,600 children with new diagnosis of esotropia (107,005) or exotropia (54,595), 43.5% were diagnosed before age of 4. Esotropic Hispanic, Black, and Asian children were diagnosed an average of 5.2 (95% CI: 2.8, 7.5),14.1 (11.2, 17.1) and 8.2 (3.2,13.3) weeks earlier compared to White children, and those with Medicaid were diagnosed 9.5 (7.9,11.2) weeks earlier compared to those with commercial insurance. Exotropic Hispanic and Asian children were diagnosed 10.6 (7.4, 13.8) and 40.9 weeks (35.3, 46.6) later than White children, and Medicaid patients (vs. commercial insurance) 12 weeks earlier (9.5, 14.4). The hazard ratio of strabismus surgery for Medicaid vs. commercial insurance was 1.28 (1.23, 1.32) for esotropia and 1.22 (1.17, 1.27) for exotropia.(Figure) Odds of developing residual amblyopia were significantly higher in children with Medicaid vs. commercial insurance both for esotropia [OR 1.75; 95%CI 1.68, 1.8] and exotropia (1.57; 1.46, 1.69).(Table) Controlling for age of strabismus diagnosis had minimal impact on our results.
Conclusions :
Strabismic children with Medicaid did not appear to have a delayed diagnosis yet were more likely to require surgery and develop residual amblyopia.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.