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  • Strabismus Surgery Lowers Injury Risk in Children

    By Lynda Seminara
    Selected by Richard K. Parrish II, MD
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    Journal Highlights

    American Journal of Ophthalmology, April 2022

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    In a previous claims database study, Pineles et al. found that the prevalence of injury among children with strabismus was 30%. Subsequently, they aimed to determine if surgery for strabismus could reduce this risk. Using data from the same source, they found that strabismus surgery lowered the risk of physical injury.

    For this study, the authors searched the OptumLabs Data Warehouse for records of patients under 19 years of age who had strabismus during the queried coverage period (2007-2018). Strabismus diagnosis was determined by ICD-9-CM codes, and surgery for strabismus was established by CPT codes. The comparative risk of injury was explored for the surgical and non­surgical cohorts. The types of physical injuries included fractures, musculo­skeletal damage, and head trauma.

    Altogether, 344,794 patients with strabismus were identified in the data­base. Of these, 26,459 (7.7%) under­went surgery to address it. The most common diagnoses were esotropia and exotropia. Hypertropia was less com­mon, and those patients were much more likely to have surgery (24.2%) than were those with esotropia (10.2%) or exotropia (9.6%).

    After the first strabismus claim, 29.8% of the nonsurgical cohort expe­rienced a documented injury, versus 21.9% of the surgical cohort postop­eratively (p < .001) during the mean follow-up periods of 4.3 and 3.8 years, respectively. The adjusted hazard ratio (HR) for the risk of any injury after strabismus surgery was 0.85. The HR was significantly lower after each type of strabismus surgery (esotropia, 0.91; exotropia, 0.82; hypertropia, 0.89). The fact that patients with exotropia were least likely to be injured postoperatively may relate to the superior binocular outcomes achieved for these patients relative to those with esotropia or hypertropia.

    “Surgery may be a factor in decreas­ing injury risk in strabismic patients, particularly in exotropia,” the authors concluded. They acknowledged that the results of this study may not necessarily apply to noninsured patients. Regard­less, given the large number of children with strabismus in the United States, the authors recommend further assess­ment of potential strategies to reduce injury in this patient population.

    The original article can be found here.