Prevalence and Types of Strabismus in Cerebral Palsy: A Global and Historical Perspective Based on a Systematic Review and Meta-Analysis

ABSTRACT

Purpose

Strabismus is more frequent in cerebral palsy (CP) than in the normal population, but reports differ how much it is increased. We here examined the global prevalence and types of strabismus in CP, whether esotropia or exotropia is more frequent, and whether the prevalence differs between ethnicities and/or country income levels, and between generations.

Methods

We compiled in a systematic review and meta-analysis the results of 147 CP studies that report the prevalence of strabismus or the ratio of esotropia to exotropia, and we conducted subgroup analyses for region (income level) and ethnicity. We performed a pooled analysis for the CP strabismus prevalence, and estimated the global number of CP cases with strabismus.

Results

The pooled prevalence of strabismus in CP is 49.8% in high-income countries and 39.8% in lower-income countries. We estimate the global number of strabismus cases in CP as 12.2 million, with 7.6 million males and 4.6 million females, based on current estimates of 29.6 million global CP cases. Esotropia is more frequent than exotropia in Caucasians, while exotropia is more frequent than esotropia in Hispanic and in some Asian and African populations. The strabismus prevalence in CP increases with increasing country income levels.

Conclusion

Generational changes in strabismus prevalence appear to reflect a transition of CP types and an increase in prevalence as countries attain higher income and more effective maternal health care. The distribution of esotropia and exotropia in CP patients largely reflects the horizontal strabismus type that is predominant in the subject’s ethnicity.

KEYWORDS:

• Cerebral palsy
• esotropia
• ethnicity
• exotropia
• geographic mapping
• global
• strabismus

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09286586.2024.2331537

Acknowledgments

The authors thank Jenny Costa (Savitt Medical Library, University of Nevada, Reno) for assistance with obtaining sources. We also thank Dr. Mitchell Strominger (University of Nevada, Reno, School of Medicine) and Dr. Wei Yang (University of Nevada, Reno, School of Public Health) for helpful comments.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institutes of Health under Grant EY031729 to CSvB; National Institutes of Health under Grant GM103554 to CSvB; and Office of Medical Research, University of Nevada, Reno, School of Medicine under a microgrant to MSH.