Ophthalmic Pathologies in Craniosynostosis: Risk Factors and Disparities in the United States.

BACKGROUND

Known ophthalmic manifestations of craniosynostosis include strabismus, papilledema, refractive errors, and amblyopia. This study uses a national database to identify risk factors and disparities in the presentation of these ocular manifestations of craniosynostosis in the last decade.

METHODS

Hospital discharges with diagnoses of craniosynostosis were identified in the 2016 to 2022 National Inpatient Sample. Admissions were additionally characterized by concurrent ophthalmic pathologies, as well as sociodemographic and clinical variables. A multivariable logistic regression model was used to evaluate independent predictors of comorbid ophthalmic pathology (P<0.05).

RESULTS

The final cohort included 39,385 discharges with craniosynostosis diagnoses from 2016 to 2022. The overall rate of ocular pathologies was 7.7%. The most common pathologies were disorders of the orbit (2.1%) and strabismus (2.0%). Syndromic craniosynostosis (OR: 2.06, 95% CI: 1.90-2.24, P<0.001) predicted higher odds of concurrent ophthalmic pathologies. Black (OR: 1.30, 95% CI: 1.15-1.47, P<0.001) and Hispanic (OR: 1.23, 95% CI: 1.11-1.35, P<0.001) race/ethnicity predicted higher odds of ophthalmic pathologies, whereas private insurance (OR: 0.85, 95% CI: 0.78-0.92, P<0.001) predicted lower odds.

CONCLUSION

Comorbid ophthalmic pathologies in patients with craniosynostosis may be common. Historically underserved populations, such as Black and Hispanic patients and publicly insured patients, may experience a disproportionate epidemiological and clinical burden from these comorbid conditions. Such findings emphasize the need for multidisciplinary partnership and early ophthalmology referral for both syndromic and nonsyndromic craniosynostosis patients.