{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T06:00:20Z","timestamp":1778220020554,"version":"3.51.4"},"reference-count":41,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T00:00:00Z","timestamp":1737417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institutes of Health","award":["UL1TR001412-07"],"award-info":[{"award-number":["UL1TR001412-07"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background\/Objectives: Strabismus, or eye misalignment, has not been well-described in U.S. military Veterans. This study was undertaken to characterize Veterans with a strabismus diagnosis as well as those who underwent strabismus surgery. Methods: A retrospective analysis of electronic health records (EHR) from the Veterans Health Administration (VHA) was conducted using patient data from 2000 to 2022. VHA-enrolled Veterans \u2265 18 years with strabismus-related International Classification of Diseases (ICD) codes and\/or Current Procedural Terminology (CPT) codes were identified. Total and demographic (age group, sex, race, and ethnicity) stratified prevalence and incidence rates were calculated, as well as sex-stratified residual lifetime risk. Results: A total of 321,639 patients had a strabismus diagnosis, with most (320,107) identified by ICD code (CPT code only = 1532). The peak prevalence was 2.29% in the 2022 VHA fiscal year (1 October 2021 to 30 September 2022) with a median annual age-adjusted incidence rate of 168.9\/100 000 enrollees. Age-adjusted lifetime risk was 10.19% for males and 11.03% for females. Significant differences by age group, sex, race, and ethnicity were identified for strabismus prevalence (p &lt; 0.001), strabismus diagnosis types (p &lt; 0.001), and between patients with strabismus who either did or did not have surgery (sex p &lt; 0.05, all others p &lt; 0.001). Compared with other U.S. adult populations, VHA Veterans have similar or higher prevalence, annual incidence rates, and lifetime risk of a strabismus diagnosis, with demographic factors significantly affecting the rates and types of strabismus. Notably, despite lower prevalence and incidence than other racial groups, a higher percentage of African American patients with strabismus underwent surgery, contrasting with published Medicare data. Inconsistencies between ICD and CPT codes highlight potential miscoding and\/or missing codes, with reliance on ICD code diagnoses potentially underestimating strabismus prevalence. Conclusions: Further characterization of factors affecting strabismus risk among these patients may help improve strabismus diagnosis and management for many US Veterans. This foundational study serves as a platform for detailed predictive analyses in determining risk outcomes for individuals. This includes better identification of at-risk individuals, informing effective resource allocation for treatment.<\/jats:p>","DOI":"10.3390\/jpm15020040","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T04:19:51Z","timestamp":1737433191000},"page":"40","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Strabismus and Strabismus Surgery in the U.S. Veterans Health Administration: Foundational Analyses of Electronic Health Record Data from 2000 to 2022"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8274-8511","authenticated-orcid":false,"given":"John H.","family":"Lillvis","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA"},{"name":"Veterans Administration Western New York Healthcare System, Buffalo, NY 14212, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Feehan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA"},{"name":"M\/A\/R\/C Research, Irving, TX 75038, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Treefa","family":"Shwani","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA"},{"name":"Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9011-4869","authenticated-orcid":false,"given":"Amy E.","family":"Millen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Environment Health, School of Public Health and Health Professions, State University of New York, University at Buffalo, Buffalo, NY 14214, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory E.","family":"Wilding","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Public Health and Health Professions, State University of New York, University at Buffalo, Buffalo, NY 14214, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3100-9545","authenticated-orcid":false,"given":"Karen M.","family":"Allison","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Flaum Eye Institute, University of Rochester, Rochester, NY 14642, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leah A.","family":"Owen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA"},{"name":"Division of Ophthalmology, Department of Surgery, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, OH 45229, USA"},{"name":"Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA"},{"name":"Department of Population Health Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA"},{"name":"Department of Obstetrics and Gynecology, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3731-142X","authenticated-orcid":false,"given":"Margaret M.","family":"DeAngelis","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA"},{"name":"Veterans Administration Western New York Healthcare System, Buffalo, NY 14212, USA"},{"name":"Neuroscience Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA"},{"name":"Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA"},{"name":"Department of Population Health Sciences, University of Utah School of Medicine, The University of Utah, Salt Lake City, UT 84132, USA"},{"name":"Department of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA"},{"name":"Genetics, Genomics and Bioinformatics Graduate Program, Jacobs School of Medicine and Biomedical Sciences, State University of New York, University at Buffalo, Buffalo, NY 14203, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1016\/j.survophthal.2021.03.005","article-title":"The impact of strabismus on psychosocial heath and quality of life: A systematic review","volume":"66","author":"Buffenn","year":"2021","journal-title":"Surv. 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