Prevalence, Predictive Factors, and Surgical Outcomes of Strabismus in High Myopia

Thammanoon  Surachatkumtonekul; Piyaphat  Jaruniphakul

doi:10.33192/smj.v78i3.278985

Authors

Thammanoon Surachatkumtonekul Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Piyaphat Jaruniphakul Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.33192/smj.v78i3.278985

Keywords:

Myopia, Strabismus, Prevalence, Predictive Value of Tests, Predictive factors, Ophthalmologic Surgical Procedures

Abstract

Objective: To determine the prevalence and predictive factors of strabismus in patients with high myopia and to evaluate the surgical outcomes of strabismus correction in this population.

Materials and Methods: This retrospective cohort study included 991 patients with high myopia (1,880 eyes) who attended Siriraj Hospital between January 2021 and June 2023. High myopia was defined as a spherical equivalent (SE) ≤ -5.0 diopters or an axial length (AL) ≥ 26.5 mm. Collected data included demographics, visual acuity, refractive error, axial length, strabismus type, and surgical outcomes. Surgical success was defined as postoperative alignment within 8 prism diopters (PD) at the 8-week follow-up. ROC curve analysis was performed to determine optimal AL cut-off values for predicting strabismus.

Results: Strabismus was identified in 6.7% (66/991) of patients. The mean SE and AL were -11.41 ± 4.87 D and 28.35 ± 2.06 mm, respectively. Patients with strabismus were younger and had longer AL compared to those without strabismus (p < 0.01). ROC analysis showed optimal AL thresholds of 27.5 mm for patients ≤18 years and 29.0 mm for patients >18 years, demonstrating high sensitivity, specificity, and predictive accuracy (AUC = 0.90 and 0.80, respectively). Surgical intervention was performed in 25 patients (37.9%), achieving a success rate of 76%.

Conclusions: Strabismus is more prevalent in individuals with high myopia than in the general population. Axial length is a strong predictor, and defined cut-offs can guide early detection. Surgical outcomes are favorable and comparable to those in non-myopic patients, supporting targeted management strategies in this population.

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