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Epidemiology of Intermittent Exotropia in Preschool Children in China
Chen-Wei Pan1, Hui Zhu, Jia-Jia Yu
1*MD, PhD †MSc ‡MD §PhD Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, Suzhou, China (C-WP); First Clinical Medical College, Nanjing Medical University, Nanjing, China (HZ); Department of Ophthalmology, Wuxi No. 2 People's Hospital, Wuxi, China (J-JY); Maternal and Child Healthcare Hospital of Yuhuatai District, Nanjing, China (HD, JB, JC); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (R-BY); and Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China (HL).
Insights
Intermittent exotropia (IXT) affects about 1 in 30 preschool children in eastern China. A history of hypoxia at birth is a significant risk factor for developing this common pediatric eye condition.
Area of Science:
- Ophthalmology
- Pediatric Eye Care
- Public Health
Background:
- Intermittent exotropia (IXT) is a common childhood eye misalignment.
- Understanding its prevalence and risk factors in diverse populations is crucial for early intervention.
Purpose of the Study:
- To determine the prevalence, subtypes, and associated risk factors for intermittent exotropia (IXT).
- Focus on preschool children aged 3 to 6 years in eastern China.
Main Methods:
- A population-based study of 5831 preschool children (aged 3-6 years) in eastern China.
- Utilized age-stratified random sampling and comprehensive eye examinations.
- Defined IXT based on established National Eye Institute criteria.
Main Results:
- The overall prevalence of IXT was 3.24%, with no significant differences by age or sex.
- Basic type IXT was most common (74.7%), followed by divergence excess (19.9%).
- A history of hypoxia at birth was strongly associated with IXT (OR 4.41).
Conclusions:
- Intermittent exotropia impacts approximately 1 in 30 Chinese preschool children, suggesting a notable public health burden.
- Hypoxia at birth is a key identified risk factor for IXT in this population.
Purpose:
To determine the prevalence, subtypes, and associated risk factors for intermittent exotropia (IXT) in preschool children aged 3 to 6 years in eastern China.
Methods:
A population-based study including 5831 preschool children aged 3 to 6 years was conducted from 2011 to 2012 in Yuhua District, Nanjing, China, using an age-stratified random sampling procedure. Clinical examinations including ocular alignment, ocular motility, visual acuity, prism cover test, cycloplegia refraction, stereopsis screening, slitlamp examination, and fundus examination were performed by trained ophthalmologists and optometrists. Intermittent exotropia was defined as an acquired intermittent exodeviation of at least 10 prism diopters in an otherwise healthy child following the classification recommended by the National Eye Institute.
Results:
The overall prevalence of IXT in this population was 3.24% (95% confidence interval, 2.79 to 3.69%), with no age (p = 0.19) and sex (p = 0.89) differences. Among 166 children with IXT, the "basic type" was the most common type of IXT (74.7%), the "divergence excess" was the second (19.9%), whereas the "convergence weakness" was the rarest (5.4%). In multivariate analysis adjusting for age, sex, and other confounders, the presence of IXT was only associated with a history of hypoxia at birth (odds ratio, 4.41; 95% confidence interval, 2.47 to 7.86).
Conclusions:
Intermittent exotropia affected approximately 1 in 30 Chinese preschool-aged children in eastern China, indicating a relatively higher burden of this pediatric eye condition in the world's most populous country. The presence of IXT was strongly associated with a history of hypoxia at birth.
