Materiały źródłowe

• #1 Strabismus – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK560782/

  The prevalence of strabismus is 2% to 5% in the general population. In the U.S., 5 to 15 million individuals are affected by strabismus. In a National Health Survey, exotropia was seen in 2.1% and esotropia in 1.2% of the population aged 4 to 74 years. This difference is due to the higher prevalence of exotropia in the population between 55 to 75 years of age. […] Fifty percent of all childhood esotropias are either fully or partially accommodative. Non-accommodative esotropia is seen in 10% of all strabismus cases and is the second most common form of childhood esotropia. […] Infantile esotropia affects 1 in every 100 to 500 persons, which accounts for 8.1% of cases of esotropia. […] Intermittent esotropia is seen in 1% of the population and is the most common form of exotropia. Exotropia is more prevalent in Asian and black populations. Women make up 60% to 70% of exotropia cases.

• #2 Investigating strabismus (summary) | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/investigating-strabismus-summary?embed_domain=hackmd.io%2F%40yipuafecsl2jsu8smr5njq%2Fbnjhjgjghjghjghfavicon.icofavicon.ico&lang=us

  Strabismus, commonly known as „crossed eyes” or „squint,” is a visual disorder characterized by the misalignment of the eyes. […] Strabismus is a relatively common condition, affecting approximately 1-4% of the population. […] The disorder often develops during early childhood, although it can also occur in adulthood. […] The exact prevalence may vary by geographic region, genetics, and environmental factors. […] MRI and CT scans may be used to evaluate the extraocular muscles, the structures within the orbit, and the neurological aspects of strabismus.

• #3 Postoperative Decompensated Strabismus Following Otherwise Uncomplicated Ocular Surgeries – EyeWiki

  https://eyewiki.org/Postoperative_Decompensated_Strabismus_Following_Otherwise_Uncomplicated_Ocular_Surgeries

  Strabismus is a common ocular disease defined as a misalignment of the eyes. It affects approximately 4% of the United States population. […] Loss of fusion in patients with preexisting strabismus has been documented following many otherwise uncomplicated ocular procedures such as laser in situ keratomileusis (LASIK) and cataract extraction and intra ocular lens (CEIOL). […] Decompensated strabismus is reported to be the most common neuro-ophthalmic visual disturbance post cataract surgery. A review of cataract surgeries noted up to 3% of patients experience diplopia following cataract extraction. […] Similarly, the most common cause of binocular diplopia in patients that underwent LASIK surgery was also decompensation of pre-existing strabismus. […] Most patients with postoperative decompensated strabismus can be corrected with prism glasses or strabismus surgery. However, a minority of patients will have persistent diplopia and require long term occlusion therapy. […] Clinicians performing ocular surgery should be aware that any post-operative visual blur can decompensate previously well controlled and asymptomatic strabismus. Visual blur induced breakdown of fusional mechanisms is believed to be the cause of most strabismus following ocular surgeries.

• #4 Strabismus (Squint) Classification and Management

  https://patient.info/doctor/strabismus-squint

  Ocular misalignments are common in newborns: one study found the prevalence of these to be about 73% in 1-month-old babies, reducing to 50% in 2-month-old babies and virtually disappearing in normal 4-month-old babies. […] Pathological misalignment affects about 5% of 5-year-olds (of these, 60% have eso-deviations and 20% have exo-deviations). This drops to around 3% of those aged 13-24. […] Esotropias appear to be more common than exotropias among Caucasians but, in the few studies looking at prevalence of this problem among non-white populations, the reverse appears to be true in West Indian children and patients of oriental descent. […] Intermittent exotropias are more common than constant exotropias, which tend to be associated with other abnormalities. […] Approximately 30% of patients with strabismus have a relative who is or was affected, and most families are concordant for the type of strabismus (eg, esotropia or exotropia).

• #5

  https://www.healthxchange.sg/news/common-strabismus-in-children

  Strabismus or squint is a condition where there is a misalignment of the eyes. The types of strabismus vary among different age groups and present differently in different parts of the world. In Asia, exotropias or divergent squints are the most common type of strabismus, consisting of 65%-85% of total childhood strabismus. On the flip side, esotropias or convergent squints are 2-4 times more common in the West than exotropias. […] Comitant squints are characteristically found in patients with congenital or early-onset strabismus. On the other hand, incomitant squints are usually a result of a restrictive cause (a tight intraocular muscle in thyroid eye disease), or a paralytic cause (an acute sixth nerve palsy causing limitation in abduction of the lateral rectus muscle on the affected side).

• #6 Strabismus | 5-Minute Pediatric Consult

  https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617089/all/Strabismus?q=Cerebral+Palsy

  For children 6 years of age, the prevalence of strabismus is 45%. […] Strabismus may cause permanent loss of three-dimensional vision, amblyopia (visual acuity loss), and/or ocular torticollis. […] Strabismus can result in significant psychosocial problems for children, which warrant attention and treatment. […] Patients with intermittent strabismus can also develop lifelong loss of depth perception and visual acuity. These children should be evaluated and potentially treated for their strabismus.

• #7 Strabismus | Select 5-Minute Pediatrics Topics

  https://www.unboundmedicine.com/5minute/view/Select-5-Minute-Pediatric-Consult/14057/all/Strabismus

  For children 6 years of age, the prevalence of strabismus is 45%. […] Strabismus can be a sign of a vision- or life-threatening neurologic problem. […] A physician needs to consider that retinoblastoma, brain tumor, cataract, and other conditions may initially present with ocular misalignment.

• #8 Prevalence of strabismus among preschool children in eastern China and comparison at a 5-year interval: a population-based cross-sectional study | BMJ Open

  https://bmjopen.bmj.com/content/11/10/e055112

  The overall prevalence rate of strabismus in NES was 5.56% (95% CI 4.54% to 6.57%), which was not significantly different from that in NPVP (4.99%, 95%CI 4.13% to 5.84%, p=0.40). […] The prevalence of strabismus appeared stable in children aged 4860 months in eastern China at a 5-year interval. The prevalence of IXT increased significantly, and the convergence insufficiency type became more prevalent in patients with IXT. Timely detection and intervention of IXT are important among preschoolers. […] A study on the epidemiology of strabismus would provide useful data to guide screening and control of strabismus at an early age. […] In this population-based NES study, we reported an overall prevalence rate of strabismus of 5.56% in children aged 4860 months in eastern China. The overall concomitant esotropia and exotropia prevalence rates are 0.56% and 4.84%, respectively, with IXT as the most common type of strabismus.

• #9 Prevalence and associated risk factors for childhood strabismus in Lhasa, Tibet, China: a cross-sectional, school-based study | BMC Ophthalmology | Full Text

  https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-020-01732-2

  To estimate the prevalence of strabismus and associated risk factors among grade one school children in Lhasa, Tibet, China. […] The prevalence of strabismus was 68/1856 (3.7%) (95%CI: 2.81,4.52), with no difference between the ages, genders, ethnicities and body mass index, while tilting ones head when writing may be a risk factor for strabismus (P=0.004). […] The prevalence of strabismus in LCES was 3.7%, which is higher than previous reports from Chinese childhood epidemiology studies. […] Strabismus is a common contributing factor to amblyopia in children, which will persist into adulthood if not treated in time. […] An accurate epidemiology of disease will help in evaluating the screening results, improving effective treatment strategies and guiding the allocation of medical resources.

• #10 Strabismus:

  https://www.contemporarypediatrics.com/view/strabismus

  Amblyopia is the most common cause of visual impairment in children, and strabismus is one of the major causes of amblyopia. In a multiethnic study of pediatric eye disease, the prevalence of strabismus ranged from 1.2% to 5.6%. In another study, Ip and colleagues examined 6-year-old children with and without eye-strain symptoms (double or blurred vision, sore eyes, headaches associated with work requiring near-vision); strabismus was found in 7.3% and 1.8%, respectively. Typically, children with strabismus and/or amblyopia have no symptoms. […] Keep in mind that strabismus seldom exists in isolation. In one study, strabismus was significantly associated with other ophthalmological abnormalities, such as amblyopia, hyperopia (hypermetropia or far-sightedness), astigmatism, and anisometropia (unequal refractive error in both eyes). These associations further emphasize the need to refer children with strabismus to an ophthalmologist for a more in-depth ocular evaluation. […] Strabismus, along with leukocoria, is a major presenting symptom of retinoblastoma. Rodrigues and colleagues found that the presence of strabismus was associated with a longer lag time to diagnosis and worse prognosis for patients with retinoblastoma.

• #11

  https://www.msjonline.org/index.php/ijrms/article/view/833

  Prevalence of squint in children in 3 – 16 years age group was 0.6%. […] History of consanguinity present in 22% of cases. […] More research is needed to validate the role of consanguinity in strabismus.

• #12

  https://journals.lww.com/njoo/fulltext/2014/22010/prevalence_and_pattern_of_strabismus_in_primary.10.aspx

  Strabismus is the most common amblyogenic factor and approximately 40% of children with manifest strabismus have amblyopia. […] In Nigeria, it is generally believed that strabismus is not common. However, few studies have been done to determine the prevalence of strabismus in Benin City, Edo State. […] The overall prevalence of tropias in this study was 0.89%. […] The prevalence of manifest strabismus in Benin City was low however there should be training of non-ophthalmic staff such as teachers to detect and refer cases of strabismus. […] The prevalence of tropias found in this study was lower than the global prevalence of 3-5% but similar to previous Nigerian and African studies. […] This further confirms the low prevalence of strabismus among Negroes. […] The most common type of manifest strabismus was esotropia; this is similar to studies in Ilorin, Ibadan, Enugu, Jos, United Kingdom, United states of America and Canada.

• #13 Prevalence of Strabismus and its type in Pediatric age group 6-15 years in a tertiary eye care hospital, Karachi – MedCrave online

  https://medcraveonline.com/BBIJ/prevalence-of-strabismus-and-its-type-in-pediatric-age-group-6-15-years-in-a-tertiary-eye-care-hospital-karachi.html

  Prevalence of strabismus was found to be 6.2% according to total numbers of patient whereas according to 74 patients (Numbers of Patients found during study), 5.2% of strabismus was found. […] Prevalence of strabismus was found to be high. The manifest strabismus was more common than latent strabismus. Squint has immediate (Childhood) and long-term (I.e. during adulthood) effects on the life of the children. Timely diagnosis and treatment can improve prognosis and thus quality of life. […] The prevalence of strabismus in Nigeria was 0.14%. […] The overall estimated prevalence of strabismus in Pakistan is 5.4%. […] The prevalence of strabismus and amblyopia varies in different parts of the world. While studies in African children showed a prevalence of between 0.5% and 4.4%, its prevalence in other parts of the world varies between 0.9% and 7.4%. […] The frequency of concomitant strabismus was 76 (87.4%) while incomitant showed least than concomitant that is 4 (4.6%) the frequency of manifest strabismus was 69 (79.3%) and latent was 5 (5.7%) respectively.

• #14 Prevalence and types of strabismus in cerebral palsy: A global and historical perspective based on a systematic review and meta-analysis | medRxiv

  https://www.medrxiv.org/content/10.1101/2024.01.23.24301684v1.full-text

  Strabismus is more frequent in cerebral palsy (CP) than in the normal population, but reports differ how much it is increased. […] The pooled prevalence of strabismus in CP is 49.8% in high-income countries and 39.8% in lower-income countries. […] 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. […] 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 subjects ethnicity.

• #15 Intermittent Divergent Squint | Iris Publishers

  https://irispublishers.com/wjovr/fulltext/intermittent-divergent-squint.ID.000506.php

  Intermittent exotropia X(T) has an estimated prevalence ranging from 0.431.7%. IXT is the most prevalent type of exotropia and has been reported to be more prevalent in females. For this reason, a child’s vision and strabismus should be regularly monitored. A diagnosis of X(T) is made using cover tests and by measuring the deviation using the prism cover test for both distance and near. The indications for surgery have been suggested to be a deviation, which is present 50% of the time (home control) and which is poorly controlled on cover testing (office control). These indications have been quantified into a score-the Newcastle Control Score (NCS) for intermittent exotropia. Factors that influence the outcome of surgery are patients age at onset of deviation, patients age at surgery, interval between onset and surgery, refractive error, degree of anisometropia, visual acuity, presence of amblyopia, presence of an A- or a V-pattern, type of exotropia, existence of binocular single vision before surgery and the angle of deviation. Surgical treatment is performed to prevent deterioration to constant exotropia, to improve distance stereoacuity and for aesthetic considerations. […] The frequency with which X(T) deteriorates to constant exotropia is unclear. Reports suggest that some cases improve over time, some remain stable and others deteriorate.

• #16 Pattern Strabismus – EyeWiki

  https://eyewiki.org/Pattern_Strabismus

  An A or V pattern is found in 15-25% of all horizontal strabismus cases. V pattern is the most common overall.

• #17

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7583393/

  In this study, the prevalence of anisometropia was 9.6%. […] The present study revealed that 22.5% of the children had clinically significant refractive error. […] In this study, children with clinically significant refractive errors were 13.3-fold more likely to have strabismus. […] Furthermore, we found that children with amblyopia were 3.9-fold more likely to have strabismus. […] In the present study, children with a family history of strabismus were 8.1-fold more likely to have strabismus, compared with children in families without a history of strabismus. […] The findings of this study indicated a relatively high prevalence of strabismus among children who visited the Department of Ophthalmology Optometry for ophthalmic care. […] The presence of amblyopia, clinically significant refractive error, age and family history of strabismus were factors significantly associated with childhood strabismus. […] Therefore, early screening for childhood strabismus is essential. […] A well-controlled community-based study is needed to confirm strabismus prevalence and predictors.

• #18

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7583393/

  The overall prevalence of childhood strabismus was 17.9% (95% confidence interval [CI]: 14.621.1). […] The prevalence of strabismus were 9.8% in children aged 5 years, 16.3% in full term-born children, and 3.6% among children with a family history of strabismus. […] Of 16.7% (97/582) children with amblyopia, 56.7% (55/97) had strabismus; of 22.5% (131/582) children with clinically significant refractive error, 52.7% (69/131) had strabismus; finally, of 9.6% (56/582) children with anisometropia, 58.9% (33/56) had strabismus. […] Both bivariate and multivariate analyses were used to assess the associations of independent variables with the prevalence of strabismus among children. […] The current study indicated that 17.9% of the children had strabismus. […] Additionally, the present study showed that 16.7% of the children had amblyopia.

• #19

  https://journals.lww.com/atmr/fulltext/2024/04000/cross_sectional_study_on_strabismus_prevalence_and.21.aspx

  Strabismus affects 1.3%5.7% of children globally, with an 11.8% prevalence in Saudi Arabia. Risk factors include low-gestational age, high refractive error, family history and parental consanguinity. Limited research in Saudi Arabia creates barriers to effective treatment and prevention. This cross-sectional study aims to investigate the prevalence and risk factors of strabismus among Saudi children, with an emphasis on genetic- and birth-related factors. […] The study highlights the significant role of genetics, especially parental consanguinity, in strabismus among Saudi children. The strong link with prematurity suggests the need for focused neonatal care. Results call for improved genetic counselling, early screening and healthcare strategies to mitigate strabismus risk, emphasising further research for intervention refinement.

• #20

  https://journals.lww.com/atmr/fulltext/2024/04000/cross_sectional_study_on_strabismus_prevalence_and.21.aspx

  Our cross-sectional study sheds light on the epidemiology and aetiology of strabismus in Saudi Arabian children. The findings underscore the significant association between parental consanguinity and the presence of strabismus, highlighting the need for increased awareness and early screening. Furthermore, our study reveals that prematurity is a substantial risk factor for strabismus in this population, while low birth weight does not appear to play a significant role. These insights can inform healthcare strategies, emphasising the importance of genetic counselling and neonatal care for children born prematurely. Further research is warranted to elucidate the underlying mechanisms and optimise intervention strategies for strabismus in Saudi Arabian children.

• #21 Prevalence and associated risk factors for childhood strabismus in Lhasa, Tibet, China: a cross-sectional, school-based study | BMC Ophthalmology | Full Text

  https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-020-01732-2

  The effects of age, sex, and ethnicity were not statistically significant (P>0.05). […] In multiple logistic regression for strabismus, writing posture was statistically significant in strabismus subjects (OR1.5; 95% CI, 1.072.08), with a higher prevalence of strabismus with incorrect writing posture (tilting ones head) when writing. […] The mean deviation angle of four participants with impaired stereopsis vision was 35.0017.80 PD, and for the remaining 45 participants with normal stereopsis vision, was 33.0011.40PD. […] Participants with stereopsis impairment showed a significant difference between esotropia (3/8) and exotropia (2/43) (P=0.026), while esotropia was more likely to affect stereopsis.

• #22

  https://link.springer.com/article/10.1007/s00417-022-05935-9

  Strabismus is associated with neurodevelopmental and neurologic disorders such as cerebral palsy, Downs syndrome, neurodevelopment delay, intellectual disability, and white matter damage of immaturity. […] The higher-than-average prevalence of strabismus in the presence of CNS defects indicates that in many cases, the cause of strabismus lies in the brain. […] Moreover, these studies depict the relationship between strabismus and obvious, well-defined neurological alterations. […] More subtle, covert neurological deficits could be the cause of strabismus in a much larger proportion of cases. […] The concept of strabismic control is another important point indicating central origin and central relevance in strabismus. […] All these unequivocally point to cerebral involvement in eye misalignment pathogenesis.

• #23 Health-related quality of life and mental health in children and adolescents with strabismus – results of the representative population-based survey KiGGS | Health and Quality of Life Outcomes | Full Text

  https://hqlo.biomedcentral.com/articles/10.1186/s12955-019-1144-7

  To estimate the effect of strabismus (squinting) on mental health and health-related quality of life aspects in children and adolescents. […] The presence of strabismus was derived by parental questionnaire, and health-related quality of life and mental health were investigated with the KINDL-R and Strengths and Difficulties Questionnaire. […] Children with strabismus had lower scores in the parent-reported KINDL-R total scale and sub-scale friends compared to children without strabismus. […] The presence of strabismus was also associated with more mental health problems like hyperactivity/inattention, and peer problems as reported by parents. […] Strabismus in children and adolescents is associated with lower health-related quality of life. […] A recent population-based study in the U.S. reported that general health-related quality of life is lower in preschool children having strabismus compared to children without strabismus.

• #24 Health-related quality of life and mental health in children and adolescents with strabismus – results of the representative population-based survey KiGGS | Health and Quality of Life Outcomes | Full Text

  https://hqlo.biomedcentral.com/articles/10.1186/s12955-019-1144-7

  Beyond health-related quality of life, chronic health conditions such as strabismus may have negative impacts on the psycho-social wellbeing and development of children. […] It has been reported that mental health impairments like anxiety and depression are highly prevalent among children with strabismus. […] We therefore aimed to investigate the association of strabismus and various aspects of mental health and health-related quality of life in a large representative population-based cross-sectional sample of children and adolescents living in Germany. […] Mental health problems were more frequent in children and adolescents with strabismus compared to those without. […] In addition to associations with quality of life, we also found that children and adolescents with strabismus were more likely to have impairments in mental health like hyperactivity/inattention, and peer problems in comparison to children without strabismus.

• #25 Health-related quality of life and mental health in children and adolescents with strabismus – results of the representative population-based survey KiGGS | Health and Quality of Life Outcomes | Full Text

  https://hqlo.biomedcentral.com/articles/10.1186/s12955-019-1144-7

  The association between strabismus and mental health is known from other studies as well. […] The psycho-social burden of strabismus could be relevant for the induction of mental health impairments. […] These findings underscore the needs for further research in the area of early identification and treatment of strabismus in childhood.

• #26 Ubijournal Journal Management 

  https://developer.ubipayroll.com/article_html.php?did=13126&issueno=0

  Introduction: Strabismus is a common visual disorder in which there is misalignment of the two eyes and it may dramatically affect the visual function. […] Conclusion: squint is a major visual health problems, affecting mostly children at primary school age, so targeting preschool children with proper screening programs will decrease the number of children with reduced visual function who are attending primary schools, hence optimizing their learning ability. […] Graham PA. Epidemiology of strabismus. Br J Ophthalmol,1974; 58:224-231 […] Theodore H Curtis 1, Maureen McClatchey, David T Wheeler, Epidemiology of Surgical Strabismus in Saudi Arabia, Ophthalmic. Epidimiology,oct 2010 ;17(5):307-14. doi: 10.3109/09286586.2010.508351.

• #27

  https://www.healthxchange.sg/news/common-strabismus-in-children

  Accommodative esotropia can be completely or partially corrected with glasses. […] Treatment options for IXT include convergence or fusion exercises, patching, over-minus lenses and surgical correction. […] All children with a squint will require a complete ocular examination to exclude any potential ocular causes of poor vision resulting in a squint, for example, a unilateral congenital cataract resulting in poor vision and hence, exodeviation of that eye. Therefore, in all children with suspected strabismus, a referral to an ophthalmologist should be made.

• #28 What information can we give to the patient about the risks of strabismus surgery | Eye

  https://www.nature.com/articles/eye2014316

  I hope to report the type, incidence, and clinical outcomes of severe complications from strabismus surgery in the United Kingdom and to help in the discussions involved in the consent process. […] The incidence of severe complications of strabismus surgery found through severe complications of strabismus surgery BOSU study reports an incidence of 1 in 400 operations. […] Globe perforation is the most commonly reported complication with almost an incidence of 1:1000, with retinal detachment and endophthalmitis being the least commonly reported complications. […] The incidence may also vary in the type of surgery performed for example, Faden procedures. […] Globe perforation is the most common severe complication of strabismus surgery. […] In the BOSU study on severe complications of strabismus surgery, the incidence was 1:1000.

• #29 What information can we give to the patient about the risks of strabismus surgery | Eye

  https://www.nature.com/articles/eye2014316

  Strategies to prevent globe perforation would be to avoid suturing in areas that have obvious scleral thinning or to perform different techniques such as hang-back procedures. […] SINS is a rare but potentially serious complication of strabismus surgery. […] The evidence from the BOSU study would suggest that those patients developing SINS should perhaps be seen by a colleague with an interest in scleritis and uveitis who may be able to treat these patients. […] In the BOSU study, a lost muscle was defined as a muscle lost peroperatively. […] In the BOSU study, this was defined as the patient presenting with an overcorrection and a 50% or more reduction in movement in the action of a previously operated muscle. […] There was one case of endophthalmitis in the 2 years of the BOSU giving this was a 3-year-old who developed endophthalmitis following a globe perforation giving an incidence of 1:24000 cases.

• #30 Diplopia (Double Vision): Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/1199512-overview

  From 2003 through 2012, there were 804,647 ambulatory and 49,790 emergency department visits annually for diplopia. Most ambulatory visits occurred with ophthalmologists (70.4%), and diplopia was frequently the primary reason for ambulatory setting (48.6%) or emergency department (36.5%) visits. […] International incidence rates of diplopia are unknown. The incidence of diplopia as a chief complaint in emergency departments is low. One study of a specialist eye hospital in London, United Kingdom, reported the incidence of diplopia as the chief complaint in only 1.4% of the presenting cases. […] Divergent pathologic processes, each with its own morbidity and mortality, can cause diplopia. However, irrespective of cause, diplopia has significant morbidity in terms of difficulty with depth perception and confusion with orientation of objects, especially when performing visually demanding tasks, such as driving a vehicle or operating tools. Therefore, in assessing visual disability after injuries, loss of binocularity accounts for a major percentage of loss of function.

• #31 Prevalence of strabismus among preschool children in eastern China and comparison at a 5-year interval: a population-based cross-sectional study | BMJ Open

  https://bmjopen.bmj.com/content/11/10/e055112

  The prevalence of strabismus appeared stable, but the pattern of strabismus underwent significant changes over the past 5 years, comparable with our previous NPVP study. The prevalence of IXT increased significantly, and the high exotropia to esotropia ratio was the most noteworthy feature in this area. More efforts on vision screening should be made in order to detect and provide intervention for IXT in the future.

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