Change in Angle Deviation After Visual Acuity Improvement in Monocular Deviated Patients

Young-Jun Woo; Jong-Hyuck Lee; Sang-Hun Rah

doi:10.3341/jkos.2009.50.12.1868

Journal List > J Korean Ophthalmol Soc > v.50(12) > 1008452

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Woo, Lee, and Rah: Change in Angle Deviation After Visual Acuity Improvement in Monocular Deviated Patients

Original Article

J Korean Ophthalmol Soc 2009;50(12):1868-1872.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.12.1868

Change in Angle Deviation After Visual Acuity Improvement in Monocular Deviated Patients

Young-Jun Woo, MD, Jong-Hyuck Lee, MD, Sang-Hun Rah, MD

Department of Ophthalmology, Wonju Christian Hospital, Yonsei University, Wonju College of Medicine, Wonju, Korea

Address reprint requests to Sang-Hun Rah, MD, Department of Ophthalmology, Wonju Christian Hospital, Yonsei University, Wonju College of Medicine #162 Ilsan-dong, Wonju 220-701, Korea. Tel: 82-33-741-0633, Fax: 82-33-745-2965, E-mail: shrah@wonju.yonsei.ac.kr

Received 28 August 2009 Accepted 3 December 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Anisometropia can lead to monocular deviation if the refractive error is not corrected. Therefore, the authors evaluated the change in angle deviation after visual acuity improvement by refractive correction in monocular deviated patients with anisometropia.

Methods

Changes in angle deviation were collated retrospectively for 9 patients with anisometric monocular deviation, 7 with monocular exotropia and 2 with monocular esotropia, according to medical records. The patients were admitted for strabismus surgery performed using cataract extraction or clear lens extraction (8 patients) or were treated nonsurgically using contact lenses for visual acuity recovery (1 patient).

Results

Prior to corrective measures, patients with exotropia had, on average, exodeviation of 40.43 PD, and those with esotropia had, on average, esodeviation of 27.50 PD. After corrective measures were taken, all 7 exotropia patients had decreased angle deviation, and, upon final evaluation, exodeviation had decreased to 21.71 PD, on average. In two exotropia patients, measures taken to correct refractive error shifted the exotropia to exophoria. There was no change in angle deviation after Corrective measures in 2 esotropia patients.

Conclusions

In cases of exotropia caused by decreased visual acuity, correction of the visual acuity should be performed first if the correction is possible. After the recovery of visual acuity, a significant decrease in angle deviation occurs.

Keywords: Anisometropia, Monocular deviation

References

1. Abrahamsson M, Fabian G, Sjostrand J. A longitudianl study of a population based sample of astigmatic children, II. The changeability of anisometropia. Acta Ophthalmol. 1990; 68:435–40.

2. Abrahamsson M, Sjostrand J. Natural history of infantile anisometropia. Br J Ophthalmol. 1996; 80:860–3.

3. Sengpiel F, Jirmann KU, Vorobyov V, Eysel UT. Strabismic suppression is mediated by inhibitory interactions in the primary visual cortex. Cereb Cortex. 2006; 16:1750–8.

4. Sjostrand J, Abrahamsson M. Risk factors in amblyopia. Eye. 1990; 4:787–93.

5. Nucci P, Drack AV. Refractive surgery for unilateral high myopia in children. J AAPOS. 2001; 5:348–51.

6. Autrata R, Rehurek J. Laser-assisted subepithelial keratectomy and photorefractive keratectomy versus conventional treatment of myopic anisometropic amblyopia in children. J Cataract Refract Surg. 2004; 30:74–84.

7. Ali A, Packwood E, Lueder G, Tychsen L. Unilateral lens extraction for high anisometropic myopia in children and adolescents. J AAPOS. 2007; 11:153–8.

8. Godts D, Trau R, Tassignon MJ. Effect of refractive surgery on binocular vision and ocular alignment in patients with manifest or intermittent strabismus. Br J Ophthalmol. 2006; 90:1410–3.

9. Nucci P, Drack AV. Refractive surgery for unilateral high myopia in children. J AAPOS. 2001; 5:348–51.

10. Sorsby A, Leary GA, Richards MJ. The optical components in anisometropia. Vis Res. 1962; 2:43–51.

11. Zadnik K, Satoriano WA, Mutti DO, et al. The effect of parental history of myopia on children's eye size. JAMA. 1994; 271:1323–7.

12. Young TL, Ronan SM, Alvear AB, et al. A second locus for familial high myopia maps to chromosome 12q. Am J Hum Genet. 1998; 63:1419–24.

13. Weiss AH. Unilateral high myopia: optical components, associated factors, and visual outcomes. Br J Ophthalmol. 2003; 87:1025–31.

14. Hussein MA, Coats DK, Muthialu A, et al. Risk factors for treatment failure of anisometropic amblyopia. J AAPOS. 2004; 8:429–34.

15. Helveston EM. Relationship between degree of anisometropia and depth of amblyopia. Am J Ophthalmol. 1966; 62:757–9.

16. Brooks SE, Johnson D, Fischer N. Anisometropia and binocularity. Ophthalmology. 1996; 103:1139–43.

17. McMullen WH. Some points in anisometropia in discussion on problem in refraction. Trans Ophthalmol Soc U K. 1939; 59:119.

18. Kivlin JD, Flynn JT. Therapy of anisometropic amblyopia. J Pediatr Ophthalmol Strabismus. 1981; 18:47–56.

19. Holmes JM, Kraker RT, Beck RW, et al. A randomized trial of prescribed patching regimens for treatment of severe amblyopia in children. Ophthalmology. 2003; 110:2075–87.

20. Nemet P, Levinger S, Nemet A. Refractive surgery for refractive errors which cause strabismus. Binocul Vis Strabismus Q. 2002; 17:187–90.

21. Hoyos JE, Cigales M, Maldonado-bas , et al. Hyperopic LASIK may work well in refractive accommodative esotropia. Ocular Surg News. 1998; 16:93–4.

22. Haw WW, Alcorn DM, Manche EE. Excimer laser refractive surgery in the pediatric population. J Pediatr Ophthalmol Strabismus. 1999; 36:173–7.

23. Sabetti L, Spadea L, D'Alessandri L, Balestrazzi E. Photorefractive keratectomy and laser in situ keratomileusis in refractive accommodative esotropia. J Cataract Refract Surg. 2005; 31:1899–903.

24. Hubel DH, Wiesel TN. Recptive fields of optic nerve fibers in th spinder monkey. J Physiol. 1960; 154:572–80.

25. Korean association for pediatric ophthalmology and strabismus, Current concepts in strabismus. 2nd ed.Seoul: Naewae Haksool;2008. p. 171–2.

Figure 1.

Serial changes in angle deviation amounts in exotropia. PD=prism diopter.

Figure 2.

Serial change of angle deviation amounts in esotropia. PD=prism diopter.

Figure 3.

Digital photograph of monocular deviation in anisometric patient before surgery.

Figure 4.

Digital photograph of recovered monocular deviation in anisometric patient after surgery.

Table 1.

Clinical data and angle deviation outcomes in patients who underwent refractive correction

No.	Age/Sex	Procedure	Follow up period	VA without correction		VA with correction		Angle deviation
No.	Age/Sex	Procedure	Follow up period	Pre-Op	Post-Op	Pre-Op	Post-Op	Pre-Op	Post-Op
1	48/F	Cataract	84	F.C/50cm	20/100	−sph17.00 –cyl4.00	−sph3.25 –cyl3.00	75△ XT	50△ XT
		extraction				Ax180 (20/70-)	Ax180 (20/50+)
2	51/F	Cataract	12	10/200	20/70	−sph8.00 –cyl2.50	−sph1.50 –cyl1.00	18△ XT	8△ X
		extraction				Ax90 (20/70)	Ax120 (20/50)
3	34/F	Clear lens	15	20/200	20/50	−sph9.00 –cyl0.50	−sph1.00 –cyl0.50	35△ XT	20△ XT
		extraction				Ax180 (20/50)	Ax90 (20/30)
4	36/F	Clear lens	14	20/200	20/70	−sph13.00	−sph2.00 +cyl2.00	40△ XT	28△ XT
		extraction				(20/50+)	Ax90 (20/30-)
5	48/F	Cataract	13	20/200	20/70-	−sph10.00 –cyl4.00	−sph2.25 +cyl1.50	45△ XT	30△ XT
		extraction				Ax90 (20/50)	Ax170 (20/30-)
6	55/F	Cataract	19	10/200	20/100	−sph9.00	−sph1.50 –cyl0.50	50△ XT	10△ XT
		extraction				(20/70)	Ax90 (20/50)
7	20/M	Clear lens	17	5/200	20/20	−sph16.00 –cyl4.00	Plano (20/20)	30△ ET	30△ ET
		extraction				Ax180 (20/30)
8	31/M	Clear lens	12	20/100	20/70	−sph8.75	−sph1.75 (20/25)	25△ ET	25△ ET
		extraction				(20/30)
No.	Age/Sex	Procedure	Follow up period	VA without correction		VA with correction		without correction	with correction
9	38/F	Contact lens	75	20/200		−sph6.50 (20/20)		20△ XT	6△ X

VA=visual acuity; XT=exotropia; X=Exophoria; ET=esotropia.

Table 2.

Changes in angle deviation after refractive error correction

	Average of angle deviation		Changed amount in angle deviation
	Pre correction	Post correction	Changed amount in angle deviation
XT	40.43±19.40PD	21.71±15.72PD	18.71PD
ET	27.50±3.54PD	27.50±3.54PD	0PD

XT=exotropia; ET=Esotropia; PD=prism diopter.

TOOLS

Similar articles