Spectacle correction trial recommended for children with hyperopia, exotropia

J Pediatr Ophthalmol Strabismus. 2011;48(5):278-284.

Spectacle correction should be considered before strabismus surgery for treating hyperopic patients with exotropia, according to a study.

"Although hyperopic correction in patients with [exotropia] resulted in a limited increase in exodeviation with a subnormal [accommodative convergence over accommodation] ratio, one-third of the patients experienced a significant increase in exodeviation," the study authors said. "A spectacle correction trial should be considered before surgery in patients with hyperopia and [exotropia]."

The prospective study included 114 patients assigned to three groups. The first group included 38 patients with exotropia and hyperopia, the second group included 35 patients with exotropia and emmetropia, and the third group included 41 patients with exotropia and myopia.

Spectacles were prescribed for all myopic patients and some hyperopic patients with astigmatism exceeding 1.5 D or amblyopia.

Mean patient age at the time of spectacle assignment was 6.9 years. Mean age at final follow-up was 9.1 years. The mean duration of spectacle use was 15.4 months. Mean follow-up was 26 months.

With spectacle correction, mean exodeviation increased appreciably in the first group but was unchanged in the second and third groups. An exotropic shift of more than 10 ∆D was seen in 13 patients in the first group after spectacle correction.

Change in exodeviation was statistically significant in the first group (P = .049 for distance and P = .002 for near).

Outcomes were similar among patients from all three groups who underwent strabismus surgery, the authors said.