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[Change in the age spectrum in strabismus surgery]
Daniela A Starosta1,2, Michael Gräf3
1Klinik und Poliklinik für Augenheilkunde, Standort Gießen, Universitätsklinikum Gießen und Marburg GmbH, Friedrichstr. 18, 35385, Gießen, Deutschland. daniela.starosta@usb.ch.
Insights
The proportion of pediatric strabismus surgery has decreased, with fewer children and more older adults undergoing extraocular muscle (EOM) operations. This shift may reflect improved vision screening and increased acquired strabismus in adults.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Oculomotor Systems
Context:
- The proportion of pediatric strabismus surgery within total eye muscle operations has seemingly declined.
- Analysis of patient age demographics undergoing extraocular muscle (EOM) surgery is crucial for understanding trends.
Purpose:
- To verify the perceived decrease in strabismus surgery among children.
- To analyze age-related trends in patients undergoing EOM surgery between 1991 and 2019.
Summary:
- A significant decrease in EOM surgeries for children (≤10 years) was observed, dropping from 50.2% to 31.8% between 1991 and 2019.
- Conversely, the proportion of patients over 50 years old increased more than threefold, from 6.5% to 22.5%.
- A 53% reduction in esotropia surgeries in children was the primary driver for the declining pediatric proportion.
Impact:
- The findings suggest enhanced vision screening in children over the past four decades.
- An increasing incidence of acquired strabismus and better patient information likely contribute to the rise in adult EOM surgeries.
- Demographic shifts play a minor role, but future demand for EOM surgery in Germany is expected to rise due to population structure.
Background:
The proportion of children undergoing strabismus surgery in the total volume of eye muscle operations appears to have decreased. To verify this we analyzed the age of patients who underwent extraocular muscle (EOM) surgery.
Methods:
The data of patients who underwent EOM surgery at the University Eye Hospital Giessen between 1991 and 2019 were reviewed and the numbers of operations in decadal age groups were compared to the German population in the respective period. In addition, the types of strabismus which led to surgery were evaluated. The data pool comprised > 25,000 surgeries involving > 60,000 muscles.
Results:
In comparison to 1991, in 2019 the proportion of children aged ≤ 10 years decreased from 50.2% to 31.8%, corresponding to a relative decrease of more than one third. The proportion of patients aged > 50 years increased from 6.5% to 22.5%, i.e., by a factor > 3, while the population ≤ 10 years in 2019 was 13% smaller than in 1991 and the population aged > 50 years increased by 37%. The major reason for the decreasing proportion of children was a 53% reduction in surgery for esotropia. We found no apparent changes in the 2nd-5th decades of life.
Discussion And Conclusion:
The lower proportion of children undergoing EOM surgery appears to indicate an improvement in vision screening during the past 4 decades. The increasing proportion of older patients may result from better information on potential treatment and increased incidence of acquired strabismus with corresponding complaints. The demographic shift played a secondary role. Due to the population structure in Germany, a further increase in the demand for EOM surgery is to be expected.
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