Knowledge, attitude, and practice toward strabismus among caregivers of children

Dear Editor, Strabismus is a common pediatric ocular disorder affecting approximately 3–5% of children worldwide, with significant consequences for visual development and psychosocial well-being.[1,2] If untreated, it can impair binocularity, stereopsis, academic performance, social functioning, and long-term self-esteem. Despite this, delayed presentation is frequent due to inadequate awareness and persistent misconceptions among caregivers. We present key findings from our evaluation of caregiver knowledge, attitudes, and practices regarding childhood strabismus using a MCQ based simple yes or no questionnaire constructed by us. Our cross sectional study assessed 458 caregivers attending the pediatric ophthalmology outpatient department of a tertiary center in South India. The demographic profile is summarized in Table 1, showing that most respondents were parents (95.6%), resided in urban areas (97.4%), and had diploma-level education or higher. General awareness of strabismus was encouraging: 78.6% accurately identified ocular misalignment, and 90% recognized the need for medical evaluation. However, significant gaps persisted. Nearly half (43.4%) were unaware of the etiology of strabismus, and more than one-third did not recognize its impact on stereopsis or social development. Prior research similarly demonstrates that caregiver education strongly influences early health-seeking behavior and understanding of pediatric strabismus.[3]Table 1: Demographic data of study participantsAttitudes were largely positive. Most caregivers (80.8%) stated that they would treat a child with strabismus like any other child, and 45.6% acknowledged potential psychosocial implications. These findings are in line with studies illustrating the psychosocial burdens of strabismus and the substantial improvement after successful treatment.[4,5] Despite favorable attitudes, practical knowledge remained limited. While 90.6% reported they would seek early evaluation, 64.6% did not know that strabismus requires treatment. Many caregivers were uncertain about available treatment modalities: Only 52.4% were aware of conservative options such as glasses, patching, or exercises, and just 42.6% recognized surgery as a treatment option. A considerable proportion remained unsure whether any effective treatment existed. This mismatch between awareness and action parallels findings from earlier studies in the Indian context, emphasizing the need for targeted education.[3]Table 2 shows the response of caregivers to questions assessing knowledge, attitude, and practice.Table 2: Response to questions assessing knowledge, attitude, and practiceOur findings highlight the importance of strengthening community education regarding childhood strabismus. Culturally appropriate visual-health messaging, parent-education programmes, and enhanced counseling during pediatric visits could bridge existing gaps. Improving caregiver literacy about the functional and psychosocial consequences of untreated strabismus will promote timely evaluation, adherence to treatment, and better long-term visual outcomes. We believe these insights add to the growing body of evidence that caregiver awareness plays a pivotal role in pediatric strabismus management and underscores the need for public-health strategies aimed at empowering caregivers with reliable information.