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Meta-Analysis
. 2016 Oct 12:6:35177.
doi: 10.1038/srep35177.

Refractive Errors and Concomitant Strabismus: A Systematic Review and Meta-analysis

Shu Min Tang  1 , Rachel Y T Chan  1 , Shi Bin Lin  2 , Shi Song Rong  1 , Henry H W Lau  1 , Winnie W Y Lau  1 , Wilson W K Yip  1 , Li Jia Chen  1   2 , Simon T C Ko  3 , Jason C S Yam  1   2
Affiliations
Meta-Analysis

Refractive Errors and Concomitant Strabismus: A Systematic Review and Meta-analysis

Shu Min Tang et al. Sci Rep. .

Abstract

This systematic review and meta-analysis is to evaluate the risk of development of concomitant strabismus due to refractive errors. Eligible studies published from 1946 to April 1, 2016 were identified from MEDLINE and EMBASE that evaluated any kinds of refractive errors (myopia, hyperopia, astigmatism and anisometropia) as an independent factor for concomitant exotropia and concomitant esotropia. Totally 5065 published records were retrieved for screening, 157 of them eligible for detailed evaluation. Finally 7 population-based studies involving 23,541 study subjects met our criteria for meta-analysis. The combined OR showed that myopia was a risk factor for exotropia (OR: 5.23, P = 0.0001). We found hyperopia had a dose-related effect for esotropia (OR for a spherical equivalent [SE] of 2-3 diopters [D]: 10.16, P = 0.01; OR for an SE of 3-4D: 17.83, P < 0.0001; OR for an SE of 4-5D: 41.01, P < 0.0001; OR for an SE of ≥5D: 162.68, P < 0.0001). Sensitivity analysis indicated our results were robust. Results of this study confirmed myopia as a risk for concomitant exotropia and identified a dose-related effect for hyperopia as a risk of concomitant esotropia.

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Figures

Figure 1
Figure 1. Flowchart of study inclusion.
Figure 2
Figure 2. Meta-analysis of the association of myopia with different types of strabismus.
The bars with squares in the middle represent 95% confidence intervals (95% CIs) and odds ratios (ORs). The central vertical solid line indicates the ORs for the null hypothesis. Diamond indicates summary OR with its corresponding 95% CI. (A) Association between myopia and strabismus. (B) Association between myopia and exotropia. (C) Association between myopia and esotropia.
Figure 3
Figure 3. Meta-analysis of the association of hyperopia with different types of strabismus.
The bars with squares in the middle represent 95% confidence intervals (95% CIs) and odds ratios (ORs). The central vertical solid line indicates the ORs for the null hypothesis. Diamond indicates summary OR with its corresponding 95% CI. (A) Association between hyperopia and strabismus. (B) Association between hyperopia and exotropia. (C) Association between hyperopia and esotropia.
Figure 4
Figure 4. Meta-analysis of the association of astigmatism with different types of strabismus.
The bars with squares in the middle represent 95% confidence intervals (95% CIs) and odds ratios (ORs). The central vertical solid line indicates the ORs for the null hypothesis. Diamond indicates summary OR with its corresponding 95% CI. (A) Association between astigmatism and strabismus. (B) Association between astigmatism and exotropia. (C) Association between astigmatism and esotropia.
Figure 5
Figure 5. Meta-analysis of the association of anisometropia with different types of strabismus.
The bars with squares in the middle represent 95% confidence intervals (95% CIs) and odds ratios (ORs). The central vertical solid line indicates the ORs for the null hypothesis. Diamond indicates summary OR with its corresponding 95% CI. (A) Association between anisometropia and strabismus. (B) Association between anisometropia and exotropia. (C) Association between anisometropia and esotropia.
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