Association Between Strabismus and Risk of Open-Angle Glaucoma: A Multicenter Retrospective Cohort Study

Background/Objectives: To evaluate the longitudinal association between strabismus and the subsequent risk of developing open-angle glaucoma (OAG), ocular hypertension (OHT), and antiglaucoma agent (AGA) initiation or OAG interventions in patients aged 65 years and older. Methods: We conducted a multicenter retrospective cohort study using the TriNetX US Collaborative Network from 1 January 2003 to 31 December 2022. Patients aged 65 years or older with an ophthalmic encounter and a first recorded diagnosis of paralytic or other strabismus were compared with patients without strabismus. Individuals with prior glaucoma, AGA use, or glaucoma procedures before or on the index date were excluded. One-to-one propensity score matching was performed for demographics, ophthalmic conditions, systemic comorbidities, healthcare utilization, and medication history. Cox models and Kaplan-Meier analyses were used to estimate 3-year risks; 1-year lag-time, follow-up duration, subtype, stratified, and control-outcome analyses were performed. Results: After matching, 20,894 patients were included in each cohort. Strabismus was not associated with a higher 3-year risk of OAG (hazard ratio (HR) = 0.833; 95% confidence interval (CI) = [0.683-1.017]), OHT (HR = 0.923; 95% CI = [0.825-1.031]), or OAG interventions (HR = 0.851; 95% CI = [0.691-1.048]). AGA initiation was lower in the strabismus cohort (HR = 0.629; 95% CI = [0.574-0.690]). Findings were generally consistent across lag-time and subtype analyses. Conclusions: First-recorded strabismus was not associated with an increased recorded risk of OAG, OHT, or OAG interventions among adults aged 65 years or older. Standard glaucoma screening should remain individualized according to established risk factors and examination findings.