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Ophthalmic Pathologies in Craniosynostosis: Prevalence and Risk Factors in the United States from the National Inpatient Sample, 2016-2022
Dylan K. Kim
*1, Samantha X. Xing
2, Lauren B. Yeager
2, Jeffrey A. Ascherman
11Division of Plastic Surgery, Columbia University Irving Medical Center, New York, NY; 2Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY
Background: Known ophthalmic manifestations of craniosynostosis include strabismus, papilledema, refractive errors, and amblyopia. This study uses a national database to estimate the prevalence and risk factors of these ocular manifestations of craniosynostosis in the last decade.
Methods: Hospital discharges with diagnoses of craniosynostosis were identified in the 2016-2022 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 39,850 discharges with craniosynostosis diagnoses from 2016-2022. The overall rate of ophthalmic pathologies was 11.4%. The most common pathologies were disorders of the orbit (2.1%) and strabismus (2.0%). Diagnoses of ophthalmic pathologies differed by age; retinopathy of prematurity and refractive errors were associated with the youngest average age (0.2 and 1.5 years), and amblyopia (6.0 years), optic atrophy (9.4 years), and blindness/low vision (11.3 years) were associated with the oldest ages. Syndromic craniosynostosis (OR: 2.53, 95% CI: 2.36-2.71,
p<0.001) predicted higher odds of concurrent ophthalmic pathologies. Black (OR: 1.24, 95% CI: 1.12-1.37,
p<0.001) and Hispanic (OR: 1.14, 95% CI: 1.05-1.23,
p=0.0025) race/ethnicity, as well as Medicaid insurance status (OR: 1.24, 95% CI: 1.16-1.34,
p<0.001), predicted higher odds of ophthalmic pathologies.
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, clinical, and financial burden from these comorbid conditions. Such findings emphasize the need for multidisciplinary partnership and early ophthalmology referral for both syndromic and non-syndromic craniosynostosis patients.
Figure 1. Average age of different ophthalmic pathologies among patients with craniosynostosis.
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