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Etiology-based strabismus classification scheme for pediatricians
Mehmet Cem Mocan1, Aishwarya Pastapur2, Lawrence Kaufman1
1Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL.
Insights
Pediatricians have limited understanding of strabismus classification and etiology. An etiology-based classification scheme can improve diagnosis and management of this common childhood eye condition.
Area of Science:
- Ophthalmology
- Pediatrics
- Medical Education
Background:
- Strabismus affects 3% of children, requiring prompt pediatrician evaluation.
- Current understanding of strabismus classification and etiology among pediatricians is limited.
- Effective management necessitates a clear grasp of underlying causes.
Purpose of the Study:
- To assess pediatricians' understanding of strabismus classification, etiology, and nomenclature.
- To propose a novel, etiology-based strabismus classification scheme for pediatricians.
- To enhance the diagnosis and management of pediatric strabismus.
Main Methods:
- A survey was administered to pediatricians (residents, fellows, attendings) at a university academic institution.
- A targeted literature review was conducted to support the proposed classification scheme.
- The study assessed knowledge of strabismus classification, etiology, and nomenclature.
Main Results:
- Only 19% of surveyed pediatricians understood strabismus etiology, 8% understood nomenclature, and none understood classification.
- Despite 69% comfort with ocular motility evaluation, deep understanding was lacking.
- An etiology-based classification with streamlined nomenclature is proposed, featuring eight categories.
Conclusions:
- Pediatricians exhibit a limited command of strabismus, irrespective of experience level.
- An etiology-based classification system can improve understanding of strabismus causes.
- This scheme aims to facilitate strabismus management in pediatric practice.
Background:
Pediatricians are regularly involved in the initial examination of children presenting with strabismus, a common ocular condition occurring in 3% of children. The objective of this review was to gain insight into pediatric residents, fellows and attendings` understanding of strabismus, and to propose an etiology-based strabismus classification scheme to aid this understanding.
Methods:
A survey was conducted in a single Department of Pediatrics in a university academic institution in order to assess the degree of understanding of the classification, etiology and nomenclature of strabismus. A targeted literature review, pertinent to our classification scheme for strabismus in the pediatric age group, is provided to clarify the various underlying etiological conditions for pediatricians.
Results:
The surveyed cohort (n=26) consisted of 10 (38.5%) attendings and 16 (61.5%) pediatricians-in-training. Although 69% of survey participants felt comfortable performing an ocular motility evaluation, only 19% had a clear understanding of the underlying etiology of strabismus, 8% had a clear understanding of strabismus nomenclature and none of the participants had clear knowledge of a classification scheme of strabismus. We propose an etiologic-based strabismus classification scheme with streamlined nomenclature geared towards Pediatricians to facilitate the management of pediatric patients with various ocular misalignments. Eight major categories of this classification scheme include (1) physiologic, (2) comitant, (3) paralytic, (4) sensory, (5) syndromic, (6) orbital, (7) supranuclear and (8) pseudostrabismus.
Conclusions:
Pediatricians at all levels of professional experience have a limited command of strabismus. An etiology-based classification scheme of strabismus may assist in understanding the underlying causes and facilitate the management of strabismus in the pediatrician`s office.
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