The Development of Myopia Among Children With Intermittent Exotropia

doi:10.1016/j.ajo.2009.10.009

American Journal of Ophthalmology

Volume 149, Issue 3, March 2010, Pages 503-507

https://doi.org/10.1016/j.ajo.2009.10.009 Get rights and content

Purpose

To describe the long-term refractive error changes in children diagnosed with intermittent exotropia (IXT) in a defined population.

Design

Retrospective, population-based observational study.

Methods

Using the resources of the Rochester Epidemiology Project, the medical records of all children (<19 years) diagnosed with IXT as residents of Olmsted County, Minnesota, from January 1, 1975 through December 31, 1994 were retrospectively reviewed for any change in refractive error over time.

Results

One hundred eighty-four children were diagnosed with IXT during the 20-year study period; 135 (73.4%) had 2 or more refractions separated by a mean of 10 years (range, 1–27 years). The Kaplan-Meier rate of developing myopia in this population was 7.4% by 5 years of age, 46.5% by 10 years, and 91.1% by 20 years. There were 106 patients with 2 or more refractions separated by at least 1 year through 21 years of age, of which 43 underwent surgery and 63 were observed. The annual overall progression was −0.26 diopters (SD ± 0.24) without a statistically significant difference between the observed and surgical groups (P = .59).

Conclusion

In this population-based study of children with intermittent exotropia, myopia was calculated to occur in more than 90% of patients by 20 years of age. Observation versus surgical correction did not alter the refractive outcome.

Section snippets

Methods

The medical records of all patients younger than 19 years who were residents of Olmsted County, Minnesota, when diagnosed by an ophthalmologist as having intermittent exotropia between January 1, 1975 and December 31, 1994 were retrospectively reviewed. Institutional review board approval was obtained for this study. Potential cases of intermittent exotropia were identified using the resources of the Rochester Epidemiology Project, a medical record linkage system designed to capture data on any

Results

One hundred eighty-four patients were diagnosed with intermittent exotropia during the 20-year period. One hundred thirty-five of the 184 (73.4%) had 2 or more refractive error measurements separated by at least 1 year, the clinical findings of which are shown in Table 1. There were 44 (33%) male and 91 (67%) female patients. The mean age at diagnosis for the 135 was 5.6 years (range, 0.9 to 14.9 years). Amblyopia was present in 4 patients (3%). The mean initial angle of deviation was 20 prism

Discussion

The findings from this population-based study of 135 children with intermittent exotropia (IXT) showed a significant trend toward myopia over time. The Kaplan-Meier rate of developing myopia in this population was 7.4% by 5 years of age, 46.5% by 10 years, and 91.1% by 20 years. Whether or not a patient underwent surgical correction did not appear to have an impact on his or her rate of myopic progression.

The initial refractive error of our population of children with intermittent exotropia is

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Cited by (55)

Refractive change in pediatric patients with intermittent exotropia
2023, Journal of AAPOS
To determine the relationship between intermittent exotropia (IXT) and refractive change and the effects of the methods applied in IXT follow-up on refractive change.
The medical records of 228 patients with IXT (group 1) and 110 patients without strabismus (group 2) who were followed between 2008 and 2022 were analyzed retrospectively. Group 1 was divided into three subgroups: overminus correction (group 1A), patients who underwent surgery (group 1B), and patients who were observed (group 1C).
Annual myopic progression was −0.21 ± 0.32 D (range, −1.26 to +1.92) in group 1 and −0.07 ± 0.30 D (range, −1.13 to +1.00) in group 2 (P < 0.001). Annual myopic progression was −0.26 ± 0.29 D (range, −1.26 D to +0.12 D) in group 1A, −0.25 ± 0.35 D (range, −1.15 D to +0.25 D) in group 1B, and −0.19 ± 0.33 D (range, −1.12 D to +1.92 D) in group 1C. There was no difference in annual myopic progression between the subgroups (P = 0.670). The annual change in myopic refraction between each of the group 1 subgroups and group 2 was statistically significantly different (P < 0.001, P = 0.023, P < 0.001, resp.).
Myopia progression was significantly greater in children with IXT than in the normal population. Myopia progression did not vary with exotropia treatment.
Association between refractive errors and horizontal strabismus: the Korea National Health and Nutrition Examination Survey
2021, Journal of AAPOS
Citation Excerpt :
Although a population-based study from China reported that myopia was significantly associated with intermittent exotropia, no causal relationship between the two could be identified because of its cross-sectional study design.2 It has been suggested that intermittent exodeviation can cause the development of myopia,10 and the relationship might be explained by changes in accommodation in patients with intermittent exodeviation.4,18 However, Shin and colleagues19 recently demonstrated that there was no difference in the rate of myopic progression between patients with both myopia and exodeviation, and those with myopia alone.
To investigate the association between refractive error and horizontal strabismus based on a Korean population-based survey.
The study included 22,887 participants >5 years of age who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011. Refractive error was classified into myopia, hyperopia, astigmatism, and anisometropia. The association between refractive error and exodeviation or esodeviation was assessed using multivariate logistic regression analysis.
After adjusting for potential confounders, the analyses revealed an increased odds ratio (OR) for exodeviation with an increasing trend according to the severity of myopia (mild myopia, OR = 1.36 [95% CI, 1.11-1.66]; moderate myopia, OR = 1.75 [95% CI, 1.36-2.26]; severe myopia, OR = 2.01 [95% CI, 1.50-2.69]; P_trend < 0.001). Hyperopia was not associated with exodeviation (P = 0.273). There were also significant associations for exodeviation with astigmatism (OR = 1.36 [95% CI, 1.16-1.59; P < 0.001]) and anisometropia (OR = 1.78 [95% CI, 1.38-2.30; P < 0.001]) In comparison, esodeviation was significantly associated with hyperopia (OR, 10.24 [95% CI, 4.43-23.70; P < 0.001]) and anisometropia (OR, 5.16 [95% CI, 2.27-11.76; P < 0.001]), while no significant association was found with myopic degree (P = 0.170) or astigmatism (P = 0.816).
Refractive error was closely associated with exodeviation and esodeviation. These risk associations should be considered when managing refractive errors.
Pickwell’s Binocular Vision Anomalies
2021, Pickwell's Binocular Vision Anomalies
Effect of Low-dose Atropine on Myopia Control in Children Operated for Intermittent Exotropia
2024, Journal of Korean Ophthalmological Society
Comparing myopic error in patients with basic and convergence insufficiency intermittent exotropia in China
2023, BMC Ophthalmology
Correlation between bilateral lateral rectus muscle recession and myopic progression in children with intermittent exotropia
2023, Scientific Reports

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Original articleThe Development of Myopia Among Children With Intermittent Exotropia

Purpose

Design

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

J AAPOS

Ophthalmology

Ophthalmology

Public Health

Comitant horizontal strabismus: an Asian perspective

Br J Ophthalmol

Refraction changes in children developing convergent or divergent strabismus

Br J Ophthalmol

On the anomalies of accommodation and refraction of the eye with a preliminary essay on physiological dioptrics

Baseline refractive and ocular component measures of children enrolled in the correction of myopia evaluation trial (COMET)

Invest Ophthalmol Vis Sci

Refraction as a basis for screening children for squint and amblyopia

Br J Ophthalmol

Emmetropisation in normal and strabismic children and the associated changes of anisometropia

Strabismus

Prevalence of hyperopia and associations with eye findings in 6- and 12-year-olds

Ophthalmology

Original article
The Development of Myopia Among Children With Intermittent Exotropia