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Refraction changes in children developing convergent or divergent strabismus
M Abrahamsson1, G Fabian, J Sjöstrand
1Department of Ophthalmology, University of Göteborg, Sweden.
Insights
This study on childhood strabismus found that esotropic eyes often develop increased hypermetropia after onset, unlike exotropic eyes. This research identifies potential risk indicators for developing strabismus in children.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Clinical Research
Background:
- Strabismus and amblyopia are common childhood visual impairments.
- Early detection and understanding refractive error progression are crucial for effective management.
- Previous studies have explored risk factors, but longitudinal refractive changes post-strabismus onset require further investigation.
Purpose of the Study:
- To analyze refractive error changes before and after strabismus onset in children.
- To identify risk indicators for developing strabismus.
- To compare refractive progression between esotropia and exotropia.
Main Methods:
- Retrospective cohort study of children born 1979-1980 in Västerås, Sweden.
- Inclusion of children diagnosed with strabismus and/or amblyopia between 1979-1988.
- Analysis of refraction values between ages 1 and 6 in 57 cases with and without amblyopia, focusing on manifest esotropia and exotropia.
Main Results:
- Esotropic cases exhibited more significant hypermetropia at strabismus detection compared to exotropic cases.
- Hypermetropia increased in the deviating eye of esotropic patients over time, while refractive errors were stable in most exotropic eyes.
- Anisometropia developed more frequently after strabismus onset in esotropic children; the deviating esotropic eye's refractive error increased, while the fixating eye tended towards emmetropization.
Conclusions:
- Refractive error progression differs significantly between esotropia and exotropia.
- Hypermetropia increase in the deviating eye is a key characteristic of esotropia development.
- Identifying these refractive patterns can aid in early detection and risk stratification for childhood strabismus.
Abstract:
Strabismus and amblyopia were studied in a cohort of children born in 1979 or 1980 in the area of Västerås, Sweden. Forty percent of the children had participated in a voluntary eye examination at 1 year of age. All children diagnosed as strabismic and/or amblyopic between 1979 and 1988 at any of the three eye clinics in the area were included in this study. Strabismic cases were mostly detected by the parents while microstrabismus and straight eye amblyopia were found at the general 4 years of age screening at children's health centres. In 57 cases with (n = 31) and without amblyopia (n = 41) it was possible to obtain several refraction values between 1 and 6 years of age. In this study we concentrated on manifest esotropia and exotropia. The aim of the study was to describe changes of refraction before and after onset of strabismus and to establish risk indicators that identified populations at risk of developing strabismus. We found that patients with esotropia show a more pronounced hypermetropia than exotropic cases at the time of detection of strabismus. This difference becomes more definite over time, since hypermetropia increased in the deviating eye in the esotropic cases while refractive errors remained stationary in most of the exotropic eyes. It was also apparent that anisometropia frequently developed after onset of strabismus in esotropic cases in contrast to exotropic cases. An increasing refractive error in the deviating esotropic eye could be combined with an emmetropisation of the fixating eye.