title: Factors associated with strabismus in spina bifida myelomeningocele.
abstract: OBJECTIVE
  Higher prevalence of strabismus in individuals with spina bifida myelomeningocele (SBM) has previously been attributed to hydrocephalus; however, SBM is associated with many other complications. This study investigates the relation between strabismus and other factors in SBM.
  
  
  METHODS
  Children aged 3 to 18 years with SBM (n = 112) received an eye examination including assessment of ocular alignment by cover or Hirschberg test. Gestational age, respiratory distress at birth, birth weight, maternal age at birth, number of shunt revisions, and spinal lesion level were also obtained. The relation between these factors and strabismus was analyzed.
  
  
  RESULTS
  Forty-two participants had strabismus. Maternal age (P = .4) and respiratory distress (P = .6) were not significantly related to strabismus. Lower birth weight was suggestive of a relation with strabismus (logistic regression, P = .05) and younger gestational age was related to strabismus (logistic regression, P = .01). Participants who had at least one shunt revision were more likely to have strabismus (Fisher's exact test, P = .038). Spinal lesion level was significantly related to strabismus with increased likelihood of strabismus for spinal lesions closer to the brain (Wald chi-square, 1,100 = 4.29, P = .038).
  
  
  CONCLUSIONS
  These findings indicate that several factors are associated with strabismus in SBM. Some of these factors (lower birth weight and younger gestational age) are associated with strabismus in the general population, whereas the association of strabismus and level of spinal lesion may be unique to SBM and may be related to the more severe brain dysmorphology associated with upper level spinal lesions.
authors.affiliation: University of Houston College of Optometry, Houston, TX, USA. handerson@optometry.uh.edu
authors.forename: Heather A
authors.initials: HA
authors.lastname: Anderson
authors.forename: Karla K
authors.initials: KK
authors.lastname: Stuebing
authors.forename: Ray
authors.initials: R
authors.lastname: Buncic
authors.forename: Malcolm
authors.initials: M
authors.lastname: Mazow
authors.forename: Jack M
authors.initials: JM
authors.lastname: Fletcher
mesh_terms: D000293:Adolescent; D001724:Birth Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D005865:Gestational Age; D006801:Humans; D008297:Male; D008423:Maternal Age; D012307:Risk Factors; D016137:Spina Bifida Cystica / Q000150:complications*; D013285:Strabismus / Q000150:complications*; D011795:Surveys and Questionnaires