Refractive error changes in children with intermittent exotropia under overminus lens therapy

Paula, Jayter Silva; Ibrahim, Fuad Moraes; Martins, Marcia Clivati; Bicas, Harley E. A.; Cruz, Antônio Augusto Velasco e

doi:10.1590/s0004-27492009000600002

Cited by 21 publications

(17 citation statements)

References 14 publications

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“…Schaeffel et al [25] showed that accommodation is not necessary for growth that reduces refractive errors during development, and may not be necessary for the normal control of eye growth, at least in chicks. In fact, previous studies on the patients with intermittent exotropia have proved that overminus lens treatment does not cause myopic progression [10,[12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have shown that small-angle esotropia following surgery was associated with a risk of amblyopia and decreased stereoacuity [2,3]. Intermitent exotropia may be treated with prisms, occlusion, orthoptic exercises, and minus lenses as non-surgical choices [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Accommodative convergence can be stimulated by adding overcorrecting minus lenses to the patient's full cycloplegic refraction; so, this should reduce the angle or frequency of an exotropic deviation or delay the surgery until the children grow up.…”

Section: Introductionmentioning

confidence: 99%

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Overcorrecting minus lens therapy in patients with intermittent exotropia: Should it be the first therapeutic choice?

et al. 2016

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To evaluate medium-term outcomes of overminus lens treatment in patients with intermittent exotropia [X(T)]. A retrospective analysis was performed of the outcomes of 19 children with X(T) who were prescribed overminus lens (-2.00 to -4.00 D) for a median period of 18 months (6-33). The success was evaluated using two assessment methods: 1. Newcastle Control System (NCS), and 2. Jampolsky's assessment. The mean age of the patients was 6.8 ± 3.3 years (range 3-14 years). After the therapy, the median NCS score significantly improved from 5 to 1 (p < 0.001). Sixteen children (84 %) showed a NCS score of 2 or less after overminus lens treatment. According to Jampolsky's assessment, 84 % of the patients showed marked improvement from the baseline (47 % had qualitative improvement, 37 % quantitative decrease in the angle of deviation in addition to a qualitative improvement). The median pre-treatment distant angle decreased from 25 prism diopters (PD) to 18 PD after the treatment (p = 0.002). Overcorrecting minus lens treatment has a reasonable rate of success in the medium term and may be advised as primary therapeutic alternative for X(T). Both NCS and Jampolsky's scoring system appear to be useful and comparable for follow-up of patients with X(T).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Overcorrecting minus lens therapy in patients with intermittent exotropia: Should it be the first therapeutic choice?

et al. 2016

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“…[16] However, neither surgical correction nor an overcorrecting minus lens altered the refractive outcome in exotropes. [17], [18] Among children treated for amblyopia, the more negative shift toward emmetropia was associated with better ocular alignment. [19] In our study, the mean negative shift of SER in the more hyperopic eye was similar in undercorrected exotropes (–0.43 D/year) and orthotropes (–0.48 D/year), which was significantly more negative than the changes in fully corrected subjects.…”

Section: Discussionmentioning

confidence: 99%

Changes in Refractive Errors Related to Spectacle Correction of Hyperopia

et al. 2014

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BackgroundHyperopic undercorrection is a common clinical practice. However, less is known of its effect on the change in refractive errors and emmetropization throughout the later years of childhood.ObjectivesTo evaluate the effect of spectacle correction on the change in refractive errors in hyperopic children less than 12 years of age with or without strabismus.Data ExtractionA retrospective cohort study was performed by a computer based search of the hospital database of patients with hyperopia, accommodative esotropia or exotropia. A total of 150 hyperopic children under 12 years of age were included. Patients were classified into four groups: 1) accommodative esotropia with full correction of hyperopia, 2) exotropia with undercorrection of hyperopia, 3) orthotropia with full correction of hyperopia, 4) orthotropia with undercorrection of hyperopia. The 4 groups were matched by initial age on examination and spherical equivalent refractive errors (SER). The main outcome measure was the change in SER (Diopter/year) in both eyes after two years of follow-up.ResultsAn overall negative shift in SER was noted during the follow-up period in all groups, except for the group with esotropia and full correction. The mean negative shift of hyperopia was more rapid in groups receiving undercorrection of hyperopia with or without strabismus. The amount of undercorrection of hyperopia was positively correlated to the magnitude of decrease in hyperopia in all patients (r = 0.289, P<0.001) and in the subgroup of patients with orthotropia (r = 0.304, P = 0.011). The amount of undercorrection of hyperopia was the only factor associated with a more negative shift in SER (OR, 2.414; 95% CI, 1.202–4.849; P = 0.013).ConclusionsThe amount of undercorrection is significantly correlated to the change in hyperopic refractive errors. Full correction of hyperopia may inhibit emmetropization during early and late childhood.

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“…Studies suggest that overminus therapy stimulates accommodative convergence and helps reduce the angle of exodeviation [5,6]. Another hypothesis is that the fusional convergence is exerted to control the exodeviation, inducing convergence accommodation and distance blur, and that overminus lenses may allow clear distance vision, facilitating fusion [7].…”

Section: Introductionmentioning

confidence: 99%

A randomized trial evaluating efficacy of overminus lenses combined with prism in the children with intermittent exotropia

et al. 2021

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Background To evaluate the efficacy of overminus lenses combined with prism spectacles in children of 3 to 6 years of age with intermittent exotropia (IXT). Methods Sixty patients with IXT were randomly assigned to the treatment and observation groups. Each group included 30 IXT children aged 3 to 6 years. The treatment group was prescribed overminus lenses of − 2.50 D incorporated with the 2 PD base-in prisms on each side. Ocular alignment, the status of binocular vision, as well as the refraction changes were carried out and followed at 1, 3, 6, and 12 months. A revised form of the Newcastle Control Score (NCS) was used to evaluate the patients’ ability to control their IXT. Results After 12 months, the mean refractive error was 1.42 ± 1.25 D, and 1.43 ± 1.12 D for the observation and the treatment group, respectively (95% CI: − 0.61 to 0.62)); the mean exotropia control score was 5.72 ± 1.28 and 1.75 ± 1.18 in the observation and the treatment group, respectively (95% CI: − 4.63 to − 3.33); the mean near stereoacuity was 2.16 ± 0.42 log arcsec and 1.91 ± 0.26 log arcsec in the observation and the treatment group, respectively (95% CI: − 0.44 to − 0.06). Conclusions In our randomized clinical trial, overminus spectacles with prism significantly improved the control of IXT and stereopsis, by reducing the angle of strabismus in children with IXT. This treatment does not appear to cause myopia, at least in the manner used this series. A further randomized trial is warranted to assess the effect of overminus spectacles with prism after the treatment has been discontinued. Trial registration This study adheres to CONSORT 2010 guidelines. Chinese Clinical Trial Registry, ChiCTR1900025243. Registered 17 August 2019.

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Refractive error changes in children with intermittent exotropia under overminus lens therapy

Cited by 21 publications

References 14 publications

Overcorrecting minus lens therapy in patients with intermittent exotropia: Should it be the first therapeutic choice?

Overcorrecting minus lens therapy in patients with intermittent exotropia: Should it be the first therapeutic choice?

Changes in Refractive Errors Related to Spectacle Correction of Hyperopia

A randomized trial evaluating efficacy of overminus lenses combined with prism in the children with intermittent exotropia

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