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Citation
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Pineles SL, Repka MX, Yu F, Velez FG, Perez C, Sim D, Coleman AL. Am. J. Ophthalmol. 2021; ePub(ePub): ePub. |
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Abstract
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PURPOSE: Previous studies have shown an association between injury risk and strabismus in Medicare-aged beneficiaries and children. The injury prevalence in strabismic children was 30% in a study of >10 million patients in the OptumLabs® Data Warehouse (OLDW). The purpose of this study was to determine whether strabismus surgery decreases the risk of injury.
DESIGN: Retrospective Cohort Study Methods: The OLDW is a de-identified, longitudinal health database which was queried for strabismic patients aged <19 years. The patients who underwent strabismus surgery were compared to those strabismic patients who did not undergo surgery for injury. Injury risk (fractures, musculoskeletal injuries, head injuries) during their insurance enrollment was calculated in the non-surgical patients following their first strabismus claim, and compared to the risk in surgical patients post-operatively.
RESULTS: There were 344,794 patients with strabismus. Surgery was performed in 26,459 (7.7%). Esotropia was the most common diagnosis (n=181195, 52.6%) followed by exotropia (n=161712, 46.9%), and hypertropia (n=43831, 12.7%). Within these groups, patients with hypertropia were significantly more likely to undergo surgery (24.2%) compared with patients with esotropia and exotropia (10.2% and 9.6%, respectively). Injuries were diagnosed after the first strabismus claim in 94,960 (29.8%) non-surgical patients vs 5790 (21.9%) post-surgical patients (p<0.001) with a mean follow-up of 4.3±3.1 vs 3.8±3.1 years, respectively. The adjusted hazard ratio for injuries was 0.85 (95%CI:0.83-0.87) for the risk of any injury after strabismus surgery. The HR was significantly decreased following surgery for each type of strabismus: esotropia (0.91,95%CI:0.88-0.94), exotropia (0.82,95% CI:0.80-0.85) and hypertropia (0.89,95%CI:0.85-0.93).
DISCUSSION: Strabismus surgery was associated with a 15% decrease in the risk of physical injury over about 4 years of follow up. Surgery may be a factor in decreasing injury risk in strabismic patients, particularly in exotropia. Given the large number of children with strabismus in United States, further assessment of strategies such as strabismus surgery to reduce injuries in children with strabismus is needed.
Language: en |