{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T16:27:45Z","timestamp":1790699265700,"version":"4.1.0"},"reference-count":45,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:00:00Z","timestamp":1784937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: To evaluate the longitudinal association between strabismus and the subsequent risk of developing open-angle glaucoma (OAG), ocular hypertension (OHT), and antiglaucoma agent (AGA) initiation or OAG interventions in patients aged 65 years and older. Methods: We conducted a multicenter retrospective cohort study using the TriNetX US Collaborative Network from 1 January 2003 to 31 December 2022. Patients aged 65 years or older with an ophthalmic encounter and a first recorded diagnosis of paralytic or other strabismus were compared with patients without strabismus. Individuals with prior glaucoma, AGA use, or glaucoma procedures before or on the index date were excluded. One-to-one propensity score matching was performed for demographics, ophthalmic conditions, systemic comorbidities, healthcare utilization, and medication history. Cox models and Kaplan\u2013Meier analyses were used to estimate 3-year risks; 1-year lag-time, follow-up duration, subtype, stratified, and control-outcome analyses were performed. Results: After matching, 20,894 patients were included in each cohort. Strabismus was not associated with a higher 3-year risk of OAG (hazard ratio (HR) = 0.833; 95% confidence interval (CI) = [0.683\u20131.017]), OHT (HR = 0.923; 95% CI = [0.825\u20131.031]), or OAG interventions (HR = 0.851; 95% CI = [0.691\u20131.048]). AGA initiation was lower in the strabismus cohort (HR = 0.629; 95% CI = [0.574\u20130.690]). Findings were generally consistent across lag-time and subtype analyses. Conclusions: First-recorded strabismus was not associated with an increased recorded risk of OAG, OHT, or OAG interventions among adults aged 65 years or older. Standard glaucoma screening should remain individualized according to established risk factors and examination findings.<\/jats:p>","DOI":"10.3390\/jcm15155823","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T09:47:41Z","timestamp":1785145661000},"page":"5823","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between Strabismus and Risk of Open-Angle Glaucoma: A Multicenter Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Chen-Ya","family":"Hung","sequence":"first","affiliation":[{"name":"School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0425-1338","authenticated-orcid":false,"given":"Shu-Han","family":"Chuang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Changhua Christian Hospital, Changhua 50006, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing-Hua","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of General Practice, Department of Medical Education, Changhua Christian Hospital, Changhua 50006, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9729-6375","authenticated-orcid":false,"given":"Yu-Pin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan"},{"name":"Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Jie","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan"},{"name":"Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Hsien","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Changhua Christian Hospital, Changhua 50006, Taiwan"},{"name":"Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1987-4413","authenticated-orcid":false,"given":"Lien-Chen","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei 11031, Taiwan"},{"name":"Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"},{"name":"Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4797-924X","authenticated-orcid":false,"given":"Wei-Yang","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Changhua Christian Hospital, Changhua 50006, Taiwan"},{"name":"Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan"},{"name":"Department of Optometry, Chung Shan Medical University, Taichung 40242, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/j.ophtha.2013.10.030","article-title":"Incidence, Types, and Lifetime Risk of Adult-Onset Strabismus","volume":"121","author":"Diehl","year":"2014","journal-title":"Ophthalmology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1080\/2576117X.2022.2124095","article-title":"Clinical Characteristics of Acquired Diplopia in Adults","volume":"72","author":"Christoff","year":"2022","journal-title":"J. Binocul. Vis. Ocul. Motil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"269","DOI":"10.3928\/01913913-20220201-01","article-title":"Trends in Etiologies, Demographics, and Neuroimaging in New-Onset Adult Strabismus at an Ophthalmic Emergency Department","volume":"59","author":"Patel","year":"2022","journal-title":"J. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.ajo.2019.09.006","article-title":"Prevalence of Sagging Eye Syndrome in Adults with Binocular Diplopia","volume":"209","author":"Goseki","year":"2020","journal-title":"Am. J. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"365","DOI":"10.3928\/01913913-20160722-02","article-title":"Strabismus in Adults Older Than 60 Years","volume":"53","author":"Granet","year":"2016","journal-title":"J. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.ajo.2014.12.003","article-title":"Quality of Life in Adults with Strabismus","volume":"159","author":"Chang","year":"2015","journal-title":"Am. J. Ophthalmol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"203.e1","DOI":"10.1016\/j.jaapos.2021.02.014","article-title":"A Prospective Study of Treatments for Adult-Onset Divergence Insufficiency-Type Esotropia","volume":"25","author":"Crouch","year":"2021","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1590\/S1807-59322009000400006","article-title":"Results of Monocular Surgery under Peribulbar Anesthesia for Large-Angle Horizontal Strabismus","volume":"64","author":"Minguini","year":"2009","journal-title":"Clinics"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1080\/02713683.2019.1660371","article-title":"Optic Nerve Traction during Adduction in Open Angle Glaucoma with Normal Versus Elevated Intraocular Pressure","volume":"45","author":"Demer","year":"2020","journal-title":"Curr. Eye Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1136\/bjophthalmol-2020-316901","article-title":"Association between Esodeviation and Primary Open-Angle Glaucoma: The 2010-2011 Korea National Health and Nutrition Examination Survey","volume":"105","author":"Kim","year":"2021","journal-title":"Br. J. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1167\/iovs.65.1.7","article-title":"Changes in Optic Nerve Head Blood Flow during Horizontal Ocular Duction","volume":"65","author":"Kawai","year":"2024","journal-title":"Invest. Ophthalmol. Vis. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"100665","DOI":"10.1016\/j.ajoc.2020.100665","article-title":"Intraocular Pressure Elevation Associated with Blood in Schlemm\u2019s Canal after Strabismus Surgery","volume":"18","author":"Wutthayakorn","year":"2020","journal-title":"Am. J. Ophthalmol. Case Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.survophthal.2017.06.007","article-title":"Aging and Ocular Tissue Stiffness in Glaucoma","volume":"63","author":"Liu","year":"2018","journal-title":"Surv. Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1007\/s10237-013-0517-9","article-title":"Age-Related Changes in Human Peripapillary Scleral Strain","volume":"13","author":"Fazio","year":"2014","journal-title":"Biomech. Model. Mechanobiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1136\/bjo.84.3.318","article-title":"Age Related Compliance of the Lamina Cribrosa in Human Eyes","volume":"84","author":"Albon","year":"2000","journal-title":"Br. J. Ophthalmol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"83","DOI":"10.2147\/EB.S361946","article-title":"Eye Movement Abnormalities in Glaucoma Patients: A Review","volume":"14","author":"Stevenson","year":"2022","journal-title":"Eye Brain"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.ajo.2025.12.009","article-title":"Strabismus Increases Glaucoma Risk in California Medicare Beneficiaries","volume":"283","author":"Ramirez","year":"2026","journal-title":"Am. J. Ophthalmol."},{"key":"ref_18","unstructured":"(2022). Information Security, Cybersecurity and Privacy Protection\u2014Information Security Management Systems\u2014Requirements (Standard No. ISO\/IEC 27001:2022)."},{"key":"ref_19","unstructured":"TriNetX (2026, February 24). Publication Guidelines. Available online: https:\/\/trinetx.com\/publication\/trinetx-publication-guidelines\/."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"286","DOI":"10.4103\/0974-9233.159714","article-title":"Orbital Causes of Incomitant Strabismus","volume":"22","author":"Lueder","year":"2015","journal-title":"Middle East Afr. J. Ophthalmol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Niu, R., Lv, P., Hao, R., and Zhang, W. (2024). Comprehensive Analysis of Strabismus Reoperations: Clinical Insights and Progression Factors. BMC Ophthalmol., 24.","DOI":"10.1186\/s12886-024-03712-2"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.ajo.2025.01.021","article-title":"Strabismus Surgery in Patients Aged over 80 Years: Indications, Safety, and Outcomes","volume":"272","author":"Yehezkeli","year":"2025","journal-title":"Am. J. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.ophtha.2025.08.028","article-title":"Strabismus and Strabismus Surgery Reoperation Rates at 1, 3, and 5 Years: Analyses from the Iris(R) Registry (Intelligent Research in Sight)","volume":"133","author":"Repka","year":"2026","journal-title":"Ophthalmology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1016\/j.jaapos.2005.05.007","article-title":"Strabismus in Senile Cataract Patients","volume":"9","author":"Spierer","year":"2005","journal-title":"J. Am. Assoc. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"119","DOI":"10.4103\/0974-9233.56222","article-title":"Cataract Surgery to Lower Intraocular Pressure","volume":"16","author":"Berdahl","year":"2009","journal-title":"Middle East Afr. J. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1016\/j.jcrs.2019.02.024","article-title":"Predictors of Patient Compliance with Follow-up Visits after Cataract Surgery","volume":"45","author":"Gupta","year":"2019","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1080\/09273972.2021.1871635","article-title":"Strabismus Patterns after Cataract Surgery in Adults","volume":"29","author":"Bergholz","year":"2021","journal-title":"Strabismus"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Sun, A., Zhao, B., Tan, M., Liu, X., and Fu, J. (2026). Clinical Characteristics and Quality of Life in Adults with Acute Comitant Acquired Esotropia. BMC Ophthalmol., 26.","DOI":"10.1186\/s12886-025-04597-5"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.ophtha.2022.11.002","article-title":"Esotropia and Exotropia Preferred Practice Pattern(R)","volume":"130","author":"Sprunger","year":"2023","journal-title":"Ophthalmology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3347","DOI":"10.1007\/s00417-023-06092-3","article-title":"Neurological Pathologies in Acute Acquired Comitant Esotropia","volume":"261","author":"Nouraeinejad","year":"2023","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1167\/iovs.02-0631","article-title":"Ultrasound Activates the Tm Elam-1\/Il-1\/Nf-Kappab Response: A Potential Mechanism for Intraocular Pressure Reduction after Phacoemulsification","volume":"44","author":"Wang","year":"2003","journal-title":"Invest. Ophthalmol. Vis. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1946","DOI":"10.1016\/j.jcrs.2009.05.061","article-title":"Intraocular Pressure Reduction after Phacoemulsification with Intraocular Lens Implantation in Glaucomatous and Nonglaucomatous Eyes: Evaluation of a Causal Relationship between the Natural Lens and Open-Angle Glaucoma","volume":"35","author":"Poley","year":"2009","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1016\/j.ophtha.2012.02.050","article-title":"Reduction in Intraocular Pressure after Cataract Extraction: The Ocular Hypertension Treatment Study","volume":"119","author":"Mansberger","year":"2012","journal-title":"Ophthalmology"},{"key":"ref_34","first-page":"CD010746","article-title":"Perioperative Medications for Preventing Temporarily Increased Intraocular Pressure after Laser Trabeculoplasty","volume":"2","author":"Zhang","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1136\/bjo.2004.052795","article-title":"A Randomised, Prospective Study Comparing Selective Laser Trabeculoplasty with Latanoprost for the Control of Intraocular Pressure in Ocular Hypertension and Open Angle Glaucoma","volume":"89","author":"Nagar","year":"2005","journal-title":"Br. J. Ophthalmol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1016\/j.jcjo.2025.11.016","article-title":"Effect of Prophylactic Dorzolamide-Timolol on Intraocular Pressure Spikes Following Phacoemulsification","volume":"61","author":"Valia","year":"2026","journal-title":"Can. J. Ophthalmol."},{"key":"ref_37","first-page":"851","article-title":"Effect of 1% Brinzolamide and 0.5% Timolol Fixed Combination on Intraocular Pressure after Cataract Surgery with Phacoemulsification","volume":"6","author":"Ornek","year":"2013","journal-title":"Int. J. Ophthalmol."},{"key":"ref_38","first-page":"190","article-title":"Effect of Latanoprost\/Timolol and Dorzolamide\/Tiomolol on Intraocular Pressure after Phacoemulsification Surgery","volume":"4","author":"Erdogan","year":"2011","journal-title":"Int. J. Ophthalmol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1001\/archopht.125.11.ecs70063","article-title":"Intraocular Pressure in Patients with Uveitis Treated with Fluocinolone Acetonide Implants","volume":"125","author":"Godfrey","year":"2007","journal-title":"Arch. Ophthalmol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"349","DOI":"10.2147\/OPTH.S6480","article-title":"Bimatoprost in the Treatment of Eyelash Hypotrichosis","volume":"4","author":"Law","year":"2010","journal-title":"Clin. Ophthalmol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"62","DOI":"10.3126\/nepjoph.v13i2.34048","article-title":"Comparison of Ocular Biometry between Primary Open Angle Glaucoma Patients and Normal Subjects","volume":"13","author":"Manandhar","year":"2021","journal-title":"Nepal. J. Ophthalmol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1136\/bjo.70.11.831","article-title":"Anterior Chamber Depth in Open Angle Glaucoma","volume":"70","author":"Caprioli","year":"1986","journal-title":"Br. J. Ophthalmol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.18240\/ijo.2023.11.21","article-title":"Axial Length and Anterior Chamber Indices in Elderly Population: Tehran Geriatric Eye Study","volume":"16","author":"Hashemi","year":"2023","journal-title":"Int. J. Ophthalmol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.ajo.2020.06.012","article-title":"Capillary Density Measured by Optical Coherence Tomography Angiography in Glaucomatous Optic Disc Phenotypes","volume":"219","author":"Ekici","year":"2020","journal-title":"Am. J. Ophthalmol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1097\/IJG.0000000000000378","article-title":"Regression Analysis of Optical Coherence Tomography Disc Variables for Glaucoma Diagnosis","volume":"25","author":"Richter","year":"2016","journal-title":"J. Glaucoma"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5823\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T10:06:37Z","timestamp":1785146797000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5823"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,25]]},"references-count":45,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15155823"],"URL":"https:\/\/doi.org\/10.3390\/jcm15155823","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,25]]}}}