Long-term Strabismus Care and Counseling Are Needed

While strabismus often begins in childhood, it can also recur or develop in adulthood after trauma, neurologic conditions or orbital disease. Regardless of age, surgical correction may be necessary—and in some cases, multiple procedures are required. Having accurate, long-term data on reoperation rates and outcomes can improve preoperative counseling. To update the 2018 report on demographic and clinical characteristics of strabismus and associated surgeries, Johns Hopkins researchers turned to the IRIS Registry’s dataset of nearly 80 million patients. Their report, published recently in Ophthalmology, confirmed current reoperation rates and identified sociodemographic disparities in care. Reoperation rates increased with duration of follow-up, suggesting a continuing need for strabismus care in children as well as adults. Photo: B. Navez/Wikicommons. Click image to enlarge. The retrospective analysis revealed that approximately 1.9 million (2.46%) patients had strabismus, with similar rates observed in male and female patients. Diagnoses were as follows: esotropia (17.8%), exotropia (21.8%), hypertropia (13.5%) and paralytic strabismus (16.1%).The researchers reported that 125,984 patients had undergone at least one surgery, 79% of which were coded as horizontal surgery. A total of 58% of these surgeries were performed in patients under 20. Reoperation rates at one, three and five years, were 5.61%; 8.53%; and 10.13%, respectively. At each time point, the lowest reoperation rates were in patients aged six to 19.Multivariable analysis showed that reoperation rates within one year were lower in Black or African American patients compared with white patients, though the risk doesn’t differ among race or ethnicity. Patients with commercial insurance and Medicaid also had lower odds ratio for reoperation than those with Medicare Part B. The odds ratios of reoperation were significantly lower in the Midwest, South and West than in the Northeastern United States.The researchers concluded that though kids make up the lion’s share of strabismus surgeries, 42% of surgeries are performed in adults, who are often overlooked when it comes to insurance coverage. They also stated that the reasons behind the sociodemographic findings warrant further investigation. They suggested that this information be used for “developing patient information and counseling, physician benchmarking and development of health insurance coverage guidelines for medical necessity, especially in the commercial sector where there are frequent limitations to strabismus surgery coverage for adults.”Click here for the journal source. Repka MX, Lum F, Li C, et al. Strabismus and strabismus surgery reoperation rates at 1, 3, and 5 years: analyses from the IRIS Registry (Intelligent Research in Sight). Ophthalmology 2025; [Epub ahead of print].This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.