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Study shows steady myopic shift in patients with strabismus and proper alignment
J Pediatr Ophthalmol Strabismus. 2009;46(5):266-272.
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Refractive changes and a progressive myopic shift correlated with age in patients with strabismus and those with normal ocular orientation, according to a study.
"Both the age-related trend in the spherical equivalent and the high hyperopic values of the distribution peak in patients with esodeviation confirm the importance of the hypermetropic refractive component," the study authors said. "The statistically significantly higher incidence of astigmatism in patients with 1 D or greater ametropia highlights its incidence in amblyopia."
The population-based study included 12,534 patients ages 6 months to 20 years examined between 2004 and 2006. Patients underwent a complete orthoptic examination.
Patients were assigned to two groups: those with orthophoria (7,784 patients) and those with strabismus (4,750). The strabismus group was subdivided into those with esodeviation (3,026 patients) and those with exodeviation (1,724 patients).
Study data showed that the mean spherical equivalent among all patients was 1.62 D. Mean spherical equivalent was 1.10 D in the orthophoria group, 3.22 D in the esodeviation group and 1.13 D in the exodeviation group.
Age-related changes in mean spherical equivalent showed a marked progressive myopic shift. Mean myopic refraction peaked at age 12 to 14 years in the overall group, orthophoria group and exodeviation group. The esodeviation group had a steadier trend in mean spherical equivalent, with no myopic shift.
The large number of patients studied in this report is impressive. Unlike many other studies of this magnitude, these patients were all evaluated by trained eye care personnel and underwent a cycloplegic refraction. The study appears to confirm the role of significant hyperopia in the etiology of esotropia and the lack of correlation of any one type of refractive error in patients with exotropia. Although this was not a longitudinal study, the lack of a myopic shift in patients with esotropia is interesting and should stimulate further investigation. Furthermore, the observed trend in the myopic shift in other patients may be helpful when considering the role of refractive surgery in pediatric patients.
– Scott E. Olitsky, MD
OSN
Pediatrics/Strabismus Board Member