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The Danish Rural Eye Study: prevalence of strabismus among 3785 Danish adults – a population-based cross-sectional study

Journal article
Authors Oscar Hultman
T. Beth Høeg
I. C. Munch
C. Ellervik
M. la Cour
Marita Andersson Grönlund
Helena Buch Hesgaard
Published in Acta Ophthalmologica
ISSN 1755-375X
Publication year 2019
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Language en
Keywords adults, esotropia, exotropia, heterotropia, population-based, prevalence, strabismus, strabismus screening, vision screening
Subject categories Ophthalmology


Purpose: To determine the prevalence of strabismus among Danish adults and to find the frequency of history of strabismus and strabismus surgery. Furthermore, to evaluate the prevalence of strabismus-associated amblyopia among participants with strabismus and to relate the results to the current national vision screening programme. Methods: In total, 3785 adults in the Danish Rural Eye Study underwent an interview regarding eye health, visual acuity measurement, Hirschberg test and retinal photography. Participants were categorized into groups based on their birth date in relation to the introduction of the national vision screening programme. Results: In total, the prevalence of strabismus was 1.1% (41/3785; 95% CI: 0.8–1.5); no differences were found in relation to gender or screening status. The prevalence of exotropia (XT) was 0.3% (12/3785; 95% CI: 0.2–0.6) and of esotropia (ET) 0.8% (29/3785; 95% CI: 0.5–1.1), resulting in an XT:ET ratio of 1:2.7. A history of strabismus was present in 4.6% (174/3785; 95% CI: 4.0–5.3), and a history of strabismus surgery was present in 0.8% (32/3785; 95% CI: 0.6–1.2) of the participants. Among participants with manifest strabismus, 24% had strabismus-associated amblyopia. Conclusion: In this first European population-based study of strabismus prevalence in adults, the prevalence was similar to three out of five previous studies using cover test. The use of Hirschberg test may have led to an underestimation of the true prevalence. The prevalence was neither related to screening status nor gender. Our results are the first to display a predominance of ET among Caucasian Scandinavian adults. © 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd

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