Description
Strabismus is an anomaly of ocular alignment, resulting in a departure from the parallel nature of a normal gaze, and affects approximately 1-5% of the population. Left uncorrected, strabismus can result in amblyopia, a permanent vision loss in an otherwise normal eye. Although strabismus can happen at any age, the peak age of onset is around 3 years. Despite being a relatively common eye problem in young children, little attention has been given to strabismus in the published literature, with limited research exploring the etiology of strabismus. This dissertation was undertaken with the goal of better understanding factors associated with the development of strabismus, and to review the psychosocial and health-related quality of life (HRQoL) implications of having strabismus in young children. Using data from the Child Health and Development Studies (CHDS), in-utero exposure to maternal smoking, alcohol, and coffee during pregnancy, as well as multiple perinatal factors, were explored as possible risk factors with the association of esotropia and exotropia, the most common forms of strabismus in children. Overall, the risk of developing esotropia or exotropia were increased in children whose mothers smoked heavily during pregnancy compared to those who did not, after controlling for covariates. No association was found in children whose mothers consumed alcohol or coffee during pregnancy compared to those who did not drink; perinatal factors, including maternal hemorrhage before delivery, delivery position, type of delivery, fetal stress, head circumference, and baby cry time, were also not found to be significantly associated with an increased risk of strabismus in this study population. The literature review highlights concerns related to self-image, social and school phobias, mental-health problems, and interpersonal relationships in children with strabismus, as well as strabismus-related distress in caregivers. Studies involving children have only recently found their place in quality of life research, with few studies examining the impact of HRQoL from strabismus or its treatments. The work of this dissertation adds to the small yet growing field of pediatric ophthalmology and strabismus. Additional research is needed to better understand the causes of strabismus, as well as the overall quality of life burden of strabismus in children
