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Alexandra Apkarian, Julie Shelton, Sudha Nallasamy; Anisometropic Astigmatism in Superior Oblique Palsy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3648.
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There is an increased rate of contralateral anisometropic astigmatism as well as ipsilateral superior oblique palsy (SOP) in patients with unicoronal synostosis (though not always coinciding in the same patient). The purpose of this study is to analyze the prevalence and laterality of anisometropic astigmatism in patients with congenital unilateral SOP without craniosynostosis, compared to the general population.
Retrospective chart review of patients age <18 years with congenital unilateral SOP who underwent ophthalmic evaluation, including refraction. A control group of patients from our practice whose referring diagnosis was conjunctivitis, who also underwent refraction, was used to compare the rate of anisometropic astigmatism in a similar demographic.
Fourteen of 95 patients (14.7%) with congenital unilateral SOP had anisometropic astigmatism ≥1.00 Diopter. Nine of these 14 patients (64%) had contralateral anisometropic astigmatism; 5/14 patients (36%) had ipsilateral anisometropic astigmatism. Of the patients with anisometropic astigmatism, 50% (7/14) had resultant amblyopia. Anisometropic astigmatism was most commonly with-the-rule (11/14; 79%). Of our control group, 0% (0/66) had anisometropic astigmatism.
There is a high prevalence of anisometropic astigmatism (more often contralateral and with-the-rule) and resultant amblyopia in patients with congenital unilateral SOP compared to the general population, likely related to head tilt and resultant facial asymmetry. It is important for congenital SOP patients to be monitored closely for anisometropia astigmatism and amblyopia. In addition, eye doctors who see children in their practice with anisometropic astigmatism should strongly consider referral to a pediatric ophthalmologist for strabismus evaluation since anisometropic astigmatism is otherwise uncommon in the general population.
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