Incidence, Types, and Lifetime Risk of Adult-Onset Strabismus

doi:10.1016/j.ophtha.2013.10.030

Ophthalmology

Volume 121, Issue 4, April 2014, Pages 877-882

https://doi.org/10.1016/j.ophtha.2013.10.030 Get rights and content

Objective

To describe the incidence and types of adult-onset strabismus in a geographically defined population.

Design

Retrospectively reviewed population-based cohort.

Participants

All adult (≥19 years of age) residents of Olmsted County, Minnesota, diagnosed with new-onset adult strabismus from January 1, 1985, through December 31, 2004.

Methods

The medical records of all potential cases identified by the resources of the Rochester Epidemiology Project were reviewed.

Main Outcome Measures

Incidence rates for adult-onset strabismus and its types.

Results

Seven hundred fifty-three cases of new-onset adult strabismus were identified during the 20-year period, yielding an annual age- and gender-adjusted incidence rate of 54.1 cases (95% confidence interval, 50.2–58.0) per 100 000 individuals 19 years of age and older. The 4 most common types of new-onset strabismus were paralytic (44.2% of cases), convergence insufficiency (15.7%), small-angle hypertropia (13.3%), and divergence insufficiency (10.6%). The incidence of adult-onset strabismus overall and its 4 most common forms significantly increased with age (P <0.001 for all), with a peak incidence in the eighth decade of life. The lifetime risk of being diagnosed with adult-onset strabismus was 4.0% in women and 3.9% in men.

Conclusions

Paralytic strabismus was the most common subtype of new-onset adult strabismus in this population-based cohort. All of the most common forms of adult-onset strabismus increased with age, especially after the sixth decade of life. Further characterization of strabismus types found in this study is warranted to better define this disorder.

Section snippets

Study Population

The study population included all Olmsted County, Minnesota, residents 19 years of age and older who were newly diagnosed with some form of strabismus from January 1, 1985, through December 31, 2004. Olmsted County is a small urban region approximately 90 miles (145 km) southeast of Minneapolis, and in 2000, approximately 70% of the county's population (124277) lived within the city limits of Rochester. The racial distribution of county residents in 2000 was 90.3% white, 4.3% Asian, 2.7% black

General Characteristics

New-onset adult strabismus developed in 753 individuals in Olmsted County, Minnesota, during the 20-year period. Three hundred forty patients (45.2%) were men and the cohort was diagnosed at a median age of 65 years (range, 19–100 years). Six-hundred forty-nine patients (86.2%) had diplopia on initial presentation. Esotropia was the primary deviation for 261 patients (34.7%), exotropia for 251 patients (33.3%), and hypertropia for 241 patients (32.0%). There were no cases of torsional diplopia

Discussion

The present study provides data on the incidence and various subtypes of adult-onset strabismus in a defined population from the upper Midwest region of the United States. The 4 most common types of new-onset strabismus were paralytic (44.2%), convergence insufficiency (15.7%), small-angle hypertropia (13.3%), and divergence insufficiency (10.6%). Based on the age- and gender-adjusted annual incidence rate of 54.1 cases per 100 000 people, strabismus would be expected to develop in

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To investigate the prevalence and incidence of strabismus in the Japanese population by age group and to estimate the subtype proportions.
A nationwide population-based cohort study.
This study investigated the number of cases with previous and new diagnoses of strabismus by age group between 2009 and 2020 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan, which includes almost all (≥95%) medical claims data. We calculated the strabismus prevalence and 1-year incidence in 2019 and analyzed the proportion of each strabismus subtype.
The strabismus prevalence was 2.154% (2 709 207/125 708 000; 95% CI, 2.152%-2.157%). It showed a bimodal distribution, with a high proportion in school and old ages (especially ≥75 years). Exotropia, esotropia, and cyclovertical strabismus proportions were 67.3%, 26.0%, and 6.7%, respectively. Cyclovertical strabismus was uncommon in patients aged ≤18 years (1.4%) and more common (10.2%) in those aged >18 years. The strabismus incidence in 2019 was 321 per 100 000 person-years (403 093/125 708 000; 95% CI, 320-322). The annual incidence proportion of cyclovertical strabismus as opposed to whole strabismus subtypes in patients aged >18 years (13.1%) was higher than that in those aged ≤18 years (1.4%).
This is the first nationwide population-based cohort study to demonstrate strabismus's overall prevalence and incidence. The high prevalence of cyclovertical strabismus in adults compared with children may suggest that cyclovertical strabismus is a primarily age-related strabismus. The high prevalence of exotropia may indicate a genetic difference between Japanese and other ethnicities.
Postoperative outcomes for unilateral congenital trochlear nerve palsy: A retrospective cohort study
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Congenital trochlear nerve palsy is the most common cause of vertical strabismus. The goal of this study was to investigate surgical outcomes after superior oblique tendon plication with or without inferior oblique recession in children and adults with unilateral congenital trochlear nerve palsy.
Data and outcomes were collected in patients with a diagnosis of unilateral congenital superior oblique palsy during a retrospective single-center study conducted at the University Hospital of Tours. A reproducible, standard ophthalmological and oculomotor examination was performed pre- and postoperatively at 1 year, including presence or absence of diplopia, vertical and horizontal deviations, and compensatory head posture. Surgical success, defined as an endpoint including absence of diplopia in primary position, absence of head tilt, and vertical deviation at distance fixation < 5 prism diopters (PD), was analyzed.
A total of fifty-seven patients (median [IQR] age of 11 years [5–42]) were analyzed. Patients experienced a significant reduction in vertical distance and near deviations (p < 0.001), compensatory head tilt (p < 0.001), and diplopia after surgery (p < 0.001). Surgical success was higher in adults (17/24, 70.8%) than in children (15/33, 45.5%), although this did not reach statistical significance (p = 0.0657).
This study suggests that plication of the superior oblique muscle tendon, with or without recession of the inferior oblique muscle, can be effective in treating unilateral congenital trochlear nerve palsy. Further studies are necessary to compare surgical procedures and investigate their efficacy in adults compared to children in the short and long term.
La paralysie congénitale du nerf trochléaire est la cause la plus fréquente de strabisme vertical. L’objectif de cette étude était d’évaluer les résultats chirurgicaux après plicature du tendon du muscle oblique supérieur avec ou sans recul du muscle oblique inférieur chez des enfants et adultes atteints de paralysie congénitale unilatérale du nerf trochléaire.
Les données ont été recueillies chez des patients atteints de paralysie congénitale unilatérale du muscle oblique supérieur à l’hôpital universitaire de Tours. Un examen ophtalmologique et oculomoteur reproductible et stéréotypé a été réalisé en pré et en post-opératoire à 1 an, incluant : présence d’une diplopie, déviations verticales et horizontales, torticolis. Le succès chirurgical, défini par un critère composite combinant l’absence de diplopie en position primaire, l’absence de torticolis et une déviation verticale lors de la fixation de loin < 5 dioptries prismatiques (DP), a été analysé.
Un total de cinquante-sept patients (âge médian [IQR] de 11 ans [5–42]) ont été analysés. Les patients ont présenté une réduction significative des déviations verticales en fixation de loin et de près (p < 0,001), de la posture compensatoire de la tête (p < 0,001) et une amélioration de la diplopie après l’intervention (p < 0,001). Le succès chirurgical était plus élevé chez les adultes (17/24, 70,8 %) que chez les enfants (15/33, 45,5 %), bien que ce résultat n’ait pas été significatif (p = 0,0657).
Cette étude suggère que la plicature du tendon du muscle oblique supérieur, avec ou sans recul du muscle oblique inférieur, pourrait être efficace dans le traitement de la paralysie congénitale unilatérale du nerf trochléaire. Des études complémentaires sont nécessaires pour comparer les procédures chirurgicales et investiguer leur efficacité chez les adultes par rapport aux enfants à court et long terme.
Demographic and clinical characteristics of age-related distance esotropia
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Age-related distance esotropia (ARDE), is an acquired, small, comitant esodeviation that is greater at distance than at near. It occurs in older adult patients without a history of neurological event or prior strabismus. It has been observed more frequently in White adults than in other racial groups. The purpose of this study was to assess the demographic and clinical characteristics of patients with ARDE presenting at a tertiary neuro-ophthalmology clinic.
In this retrospective study, ICD-9/10 (ICD-9 378.85 and ICD-10 H51.8) codes were used to identify all patients with ARDE from 2005 to 2020 seen in a single tertiary neuro-ophthalmology clinic. ARDE was defined as esotropia greater at distance than near with associated clinical signs of adnexal tissue laxity. Patients with history or findings compatible with other etiologies of strabismus, such as thyroid eye disease, neuromuscular disorders, sensory deviations, sudden onset of diplopia, and high myopia, as well as those with prior strabismus surgery, were excluded.
A total of 89 patients (59 females [66%]) met inclusion criteria. Mean patient age was 76.6 years. All patients were White except for a single patient of African descent. Mean follow-up time was 25.2 months. Mean esodeviation at distance on presentation was 6.6^Δ. Of the 87 patients electing nonsurgical treatment, 80 achieved remission of diplopia symptoms with prism therapy alone. Of the 89 patients, 59 had no neuroimaging.
ARDE in our neuro-ophthalmology clinic population was diagnosed almost exclusively in older White adults. Prism therapy was effective for a majority of our patients.
Binocular diplopia: A retrospective study of 204 cases
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Describir la prevalencia y forma de presentación de las distintas causas de diplopía binocular en nuestro medio.
Estudio unicéntrico de corte transversal, retrospectivo en el que se revisaron todos los pacientes cuyo síntoma principal fuera el de diplopía binocular sin causa conocida visitados en un hospital terciario entre mayo 2019 y junio 2021. A todos los pacientes se les había realizado una visita neurooftalmológica completa y las pruebas complementarias necesarias para el diagnóstico etiológico de diplopía en cada caso. Se recogieron variables demográficas, patrón de desviación ocular, resultados de pruebas complementarias y diagnósticos.
En el período de estudio, 204 pacientes fueron visitados por diplopía binocular. Las causas más frecuentes de diplopía de forma global fueron paresia del iv nervio craneal (19,12%), paresia del vi nervio craneal (14,71%), estrabismos decompensados (14,22%), «sagging eye syndrome» (12,25%), paresia del iii nervio craneal (10,78%), miastenia (7,35%), trastornos supranucleares (6,37%) y endotropía miópica (5,88%). El 51% de los casos tuvieron una presentación aguda (≤ 2 semanas). Las causas más frecuentes de diplopía de aparición aguda fueron paresia del vi nervio craneal (27,88%), paresia del iii nervio craneal (21,15%), paresia del iv nervio craneal (19,23%), trastornos supranucleares (12,5%) y estrabismos descompensados (6,73%). Las causas más frecuentes de presentación subaguda/crónica (> 2 semanas) fueron estrabismos descompensados (22%), «sagging eye syndrome» (22%), paresia del iv nervio (19%), endotropía miópica (12%) y miastenia (11%).
Las etiologías más frecuentes de diplopía de forma global en nuestro medio fueron las paresias de iv nervio seguidas por las paresias del vi nervio, los estrabismos descompensados y los «sagging eye syndrome». Conocer la frecuencia de cada causa de diplopía ayuda a priorizar las pruebas en cada caso.
To describe the prevalence and form of onset of different causes of binocular diplopia in our setting.
We conducted a single-centre, cross-sectional, retrospective study reviewing the medical records of all patients visiting a tertiary-level centre between May 2019 and June 2021 with binocular diplopia as the main symptom. All patients underwent a complete neuro-ophthalmological evaluation and complementary tests for the aetiological diagnosis of diplopia. Data were collected on demographic variables, ocular deviation pattern, complementary test results, and diagnosis.
A total of 204 patients with binocular diplopia were identified during the study period. The most frequent causes of diplopia overall were fourth nerve palsy (19.12%), sixth nerve palsy (14.71%), decompensated strabismus (14.22%), sagging eye syndrome (12.25%), third nerve palsy (10.78%), myasthenia (7.35%), supranuclear disorders (6.37%), and myopic esotropia (5.88%). Presentation was acute (≤ 2 weeks progression) in 51% of cases. The most frequent causes of acute-onset diplopia were sixth nerve palsy (27.88%), third nerve palsy (21.15%), fourth nerve palsy (19.23%), supranuclear disorders (12.5%), and decompensated strabismus (6.73%). The most frequent causes of subacute/chronic presentation (more than 2 weeks) were decompensated strabismus (22%), sagging eye syndrome (22%), fourth nerve palsy (19%), myopic esotropia (12%), and myasthenia (11%).
The most frequent aetiology of diplopia in our environment was fourth nerve palsy, followed by sixth nerve palsy, decompensated strabismus, and sagging eye syndrome. Knowing the frequency of each cause of diplopia can help prioritise neuroimaging studies in each case.
Reliability and agreement analysis among 5 subjective methods of ocular torsion measurement
2022, Archivos de la Sociedad Espanola de Oftalmologia
Evaluar la fiabilidad en la medición de la torsión ocular y la concordancia de los siguientes métodos subjetivos: test de Maddox bilateral, sinoptóforo, torsionómetro de Gracis, pantalla de Harms y test de ciclodesviaciones de Awaya.
Se seleccionaron pacientes con estrabismo vertical adquirido en la edad adulta y se realizó la medición de la torsión ocular con los 5 métodos descritos en 3 ocasiones. Al no existir un gold standard en la medición subjetiva de la torsión ocular, se eligió como prueba de referencia aquella que obtuviera mejores datos de repetibilidad.
Veinticinco pacientes fueron incluidos en el estudio. Se estudió la repetibilidad de cada prueba: test de Maddox bilateral (CCI = 0,783, CV = 29,33%), sinoptóforo (CCI = 0,976, CV = 6,71%), torsionómetro de Gracis (CCI = 0,937, CV = 20,10%), pantalla de Harms (CCI = 0,962, CV = 11,86%) y test de Awaya (CCI = 0,987, CV = 52,58%). La prueba de referencia para comparar la concordancia fue el sinoptóforo. Se encontraron diferencias estadísticamente significativas al comparar los rangos de torsión ocular entre el sinoptóforo y el torsionómetro de Gracis (p = 0,008) y entre el sinoptóforo y el test de Awaya (p = 0,02).
El test de Maddox bilateral, el sinoptóforo, el torsionómetro de Gracis y la pantalla de Harms son métodos fiables con buenos índices de reproducibilidad. Entre ellos, el sinoptóforo es el método más consistente. El test de Awaya no demostró buena fiabilidad. El test de Maddox bilateral, el torsionómetro de Gracis y la pantalla de Harms fueron métodos con buena concordancia con el sinoptóforo, que se determinó como test de referencia. El test de Awaya no demostró buena concordancia con el sinoptóforo.
To evaluate the reliability in the measurement of ocular torsion and the agreement of the following subjective methods: double Maddox test, synoptophore, Gracis torsionometer, Harms screen and Awaya cyclodeviation test.
Patients with vertical strabismus acquired in adulthood were recruited and ocular torsion was measured with the 5 methods described on 3 occasions. As a gold standard test does not exist, the one that obtained the best repeatability data was chosen as the reference test.
Twenty-five patients were included in the study. The repeatability of each test was studied: double Maddox test (ICC = 0.783, CV = 29.33%), synoptophore (ICC = 0.976, CV = 6.71%), Gracis torsionometer (ICC = 0.937, CV = 20.10%), Harms screen (ICC = 0.962, CV = 11.86%) and Awaya test (ICC = 0.987, CV = 52.58%). The reference test to compare the agreement was the synoptophore. Statistically significant differences were found when comparing the ocular torsion ranges between the synoptophore and the Gracis torsionometer (P = .008) and between the synoptophore and the Awaya test (P = .02).
The double Maddox test, the synoptophore, the Gracis torsionometer, and the Harms screen are reliable methods with good reproducibility indices. Among them, the synoptophore is the most consistent method. The Awaya test did not show good reliability. The bilateral Maddox test, the Gracis torsionometer, and the Harms screen were methods with good agreement with the synoptophore, which was determined as the reference test. The Awaya test did not show good agreement with the synoptophore.
The impact of strabismus on psychosocial heath and quality of life: a systematic review
2021, Survey of Ophthalmology
Citation Excerpt :
Using the most current World Health Organization (WHO) regional groups, the highest and lowest pooled prevalence of strabismus exist in the Americas and Africa, respectively (Table 1) [55]. As individuals live longer, they are more likely to develop strabismus [93]. The worldwide estimated pooled prevalence of strabismus is 1.78% in individuals less than 20 years of age and 3.29% in those above 20 years of age [55].
Strabismus can hinder an individual's ability to perform daily functions and negatively affect their well-being. I examine the impact strabismus has on psychosocial health and quality of life in children and adults and evaluate the challenges confronted by parents of children with strabismus. Numerous misconceptions exist regarding the impact strabismus has on overall health. Negative attitudes persist toward those affected, resulting in difficulties with self-image. Individuals with strabismus are at increased risk for both visual system and psychiatric disorders. Misinformation regarding available treatment options for children and adults with strabismus continues to exist, resulting in decreased access to care. Improved education of health care providers can increase appropriate referrals and initiation of treatment. Treatment of strabismus is not merely cosmetic and has the potential to improve psychosocial health and quality of life for children and adults with and without diplopia.

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: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Supported by the National Institutes of Health, Bethesda, Maryland (grant nos.: UL1 RR024150, R01 AG034676, and UI0EY018810 [JMH]); and in part an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York.

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Original articleIncidence, Types, and Lifetime Risk of Adult-Onset Strabismus

Objective

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Section snippets

Study Population

General Characteristics

Discussion

Ophthalmic Physiol Opt

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

J AAPOS

Ophthalmology

Mayo Clin Proc

J AAPOS

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

J Neurol Sci

Ophthalmology

J AAPOS

J AAPOS

Surv Ophthalmol

Original article
Incidence, Types, and Lifetime Risk of Adult-Onset Strabismus