Elsevier

Ophthalmology

Volume 116, Issue 11, November 2009, Pages 2128-2134.e2
Ophthalmology

Original article
Prevalence of Amblyopia and Strabismus in White and African American Children Aged 6 through 71 Months: The Baltimore Pediatric Eye Disease Study

https://doi.org/10.1016/j.ophtha.2009.04.034Get rights and content

Objective

To determine the age-specific prevalence of strabismus in white and African American children aged 6 through 71 months and of amblyopia in white and African American children aged 30 through 71 months.

Design

Cross-sectional, population-based study.

Participants

White and African American children aged 6 through 71 months in Baltimore, MD, United States. Among 4132 children identified, 3990 eligible children (97%) were enrolled and 2546 children (62%) were examined.

Methods

Parents or guardians of eligible participants underwent an in-home interview and were scheduled for a detailed eye examination, including optotype visual acuity and measurement of ocular deviations. Strabismus was defined as a heterotropia at near or distance fixation. Amblyopia was assessed in those children aged 30 through 71 months who were able to perform optotype testing at 3 meters.

Main Outcome Measures

The proportions of children aged 6 through 71 months with strabismus and of children aged 30 through 71 months with amblyopia.

Results

Manifest strabismus was found in 3.3% of white and 2.1% of African American children (relative prevalence [RP], 1.61; 95% confidence interval [CI], 0.97–2.66). Esotropia and exotropia each accounted for close to half of all strabismus in both groups. Only 1 case of strabismus was found among 84 white children 6 through 11 months of age. Rates were higher in children 60 through 71 months of age (5.8% for whites and 2.9% for African Americans [RP, 2.05; 95% CI, 0.79–5.27]). Amblyopia was present in 12 (1.8%) white and 7 (0.8%) African American children (RP, 2.23; 95% CI, 0.88–5.62). Only 1 child had bilateral amblyopia.

Conclusions

Manifest strabismus affected 1 in 30 white and 1 in 47 African American preschool-aged children. The prevalence of amblyopia was <2% in both whites and African Americans. National population projections suggest that there are approximately 677 000 cases of manifest strabismus among children 6 through 71 months of age and 271 000 cases of amblyopia among children 30 through 71 months of age in the United States.

Financial Disclosure(s)

The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Section snippets

Methods

The Baltimore Pediatric Eye Disease Survey was designed to estimate and compare the prevalence of decreased VA, strabismus, amblyopia, and refractive error in a population-based sample of African American and non-Hispanic white children 6 through 71 months of age living in Baltimore. A detailed description of the Baltimore Pediatric Eye Disease Survey protocol has been published.26 The protocol was approved by the Committee on Human Subjects Research at the Johns Hopkins Bloomberg School of

Study Cohort

Data were collected between November 2003 and May 2007. A total of 63 737 occupied dwelling units were identified in 54 census tracts, of which 59 045 (93%) responded to household screening for eligible children (i.e., stated whether or not children meeting eligibility criteria lived in the house). We enrolled 3990 (97%) of the 4132 eligible children and examined a total of 2546 children (151 of whom were examined in their homes) with an overall response rate of 64% (62% of all eligible

Discussion

This population-based study of preschool African American and white children found the overall prevalence of strabismus to be 2.1% among African Americans and 3.3% among whites, a difference that was not statistically significant. Esotropia and exotropia were found equally often in both racial groups. Both exotropia and esotropia were about 3 times more frequent in children after 12 months of age compared with the first year of life. The amblyopia prevalence (for those 30–71 months of age) was

Acknowledgments

The authors thank the Data Monitoring and Oversight Committee for assistance with the design and conduct of this work as well as for reviewing and providing comments on the manuscript: Jonathan M. Holmes, MD (Chair); Eileen E. Birch, PhD; Karen Cruickshanks, PhD; Natalie Kurinij, PhD; Graham E. Quinn, MD; Maureen G. Maguire, PhD; Joseph M. Miller, MD; Karla Zadnik, OD, PhD.

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    Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

    Supported by the National Eye Institute, National Institutes of Health, Bethesda, MD (EY14483).

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