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Risk factors for strabismus and amblyopia in young Singapore Chinese children
Audrey Chia1, XiaoYu Lin, Mohamed Dirani
1Singapore National Eye Center, Singapore 168751. wla_chia@yahoo.com
Insights
Family history and refractive errors like astigmatism are key risk factors for strabismus and amblyopia in young Singaporean children. These findings emphasize the role of genetics and vision problems in early childhood eye conditions.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Public Health
Background:
- Strabismus and amblyopia are significant causes of visual impairment in children.
- Early detection and intervention are crucial for optimal visual outcomes.
- Understanding risk factors can inform targeted screening and prevention strategies.
Purpose of the Study:
- To identify risk factors associated with strabismus and amblyopia in young Singaporean Chinese children.
- To investigate the influence of family history, refractive errors, and demographic factors.
Main Methods:
- A population-based cross-sectional study (STARS) involving 3009 children aged 6-72 months.
- Strabismus diagnosed via cover test; amblyopia assessed using visual acuity, refractive error, and cover test findings.
- Parental questionnaires collected data on family, prenatal, and birth histories.
Main Results:
- Prevalence: 1.2% strabismus (primarily exotropia) and 0.8% amblyopia.
- Strabismus risk factors: astigmatism ≥1.00 D, amblyopia, sibling with strabismus, and lower parental education.
- Amblyopia risk factors: anisometropia ≥1.00 D and astigmatism ≥1.00 D.
Conclusions:
- Family history is a significant predictor for strabismus in this population.
- Refractive errors, including astigmatism and anisometropia, are strongly associated with both strabismus and amblyopia.
- These identified factors are particularly relevant for early childhood eye health in the Singapore Chinese population.
Purpose:
To determine the risk factors for strabismus and amblyopia in young Singapore Chinese children.
Methods:
A total of 3009 children were recruited for the population-based cross-sectional Strabismus, Amblyopia and Refractive Error in Singaporean Preschoolers Study (STARS). Strabismus was defined as any tropia identified on cover test. Visual acuity was measured in children aged 30-72 months with a logMAR chart where possible and the Sheridan-Gardiner test if not. Amblyopia was defined based on visual acuity and refractive error or presence of strabismus or past/present visual axis obstruction. Parents completed questionnaires on family, prenatal and birth histories.
Results:
Our study showed that 24 children aged 6-72 months (1.2%) had strabismus (20 with exotropia), and 20 children aged 30-72 months (0.8%) were amblyopic. After multivariate analysis, strabismus was associated with astigmatism ≥1.00 diopter (D; p = 0.03), amblyopia (p = 0.003), a sibling with strabismus (p < 0.001), and families with lower parental education (p = 0.04). In addition to strabismus, amblyopia was associated with anisometropia ≥1.00 D (p < 0.001) and astigmatism ≥1.00 D (p < 0.001). No association was noted between either strabismus or amblyopia and prematurity, maternal age or smoking.
Conclusion:
This study highlights the importance of family history in strabismus, and the close associations between refractive error and strabismus with amblyopia. These factors play a more important role in young Singapore Chinese children.
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