Pediatric cataract surgery may increase the risk of strabismus or nystagmus

Children with cataracts who undergo surgery, particularly at a very young age, are more likely to develop strabismus or nystagmus.

Study design

This was a retrospective review of deidentified data from 1636 patients in Optum’s 2003–2015 Clinformatics Data Mart Database who were diagnosed with cataracts prior to age 13 years. Of this group, 267 underwent cataract surgery. The prevalence of strabismus (esotropia, exotropia, heterotropia, vertical strabismus) and nystagmus were calculated from diagnostic codes in the patients’ records.

Outcomes

Children who underwent cataract surgery had a higher incidence of strabismus (48.3%) and nystagmus (12.0%) than patients who did not require cataract surgery (22.3% and 5.6%, respectively). As well, children who were diagnosed with cataracts at age ≤12 months were more likely to have strabismus or nystagmus than children who were diagnosed at an older age.

Limitations

The database contained only commercial and Medicare Advantage claims, excluding the Medicaid population. Therefore, the actual prevalence of strabismus and nystagmus may be different from what the investigators noted. The database also did not include information regarding whether patients had unilateral or bilateral cataracts.

Clinical significance

Nystagmus and strabismus are more common in children with cataracts, especially those who were diagnosed prior to age ≤12 months or underwent cataract surgery. Almost half of children who underwent cataract surgery had strabismus, which needs to be managed in order to optimize visual function and outcomes.

Financial Disclosures: Dr. Brenda Bohnsack discloses no financial relationships.