June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Three-Year Change in Refractive Error Associated with Overminus Lens Treatment for Children with Intermittent Exotropia
Author Affiliations & Notes
  • Angela Chen
    Southern California College of Optometry, Fullerton, California, United States
  • Sergul Ayse Erzurum
    Eye Care Associates, Inc., Poland, Ohio, United States
  • Danielle L Chandler
    Jaeb Center for Health Research, Tampa, Florida, United States
  • Amra Hercinovic
    Jaeb Center for Health Research, Tampa, Florida, United States
  • John W Erickson
    Nemours Children's Clinic, Jacksonville, Florida, United States
  • Marilyn Vricella
    SUNY College of Optometry, New York, New York, United States
  • Benjamin H Ticho
    Ticho Eye Associates, Chicago Ridge, Illinois, United States
  • Silvia Han
    Southern California College of Optometry, Fullerton, California, United States
  • Amy L Waters
    Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
  • Paula S McDowell
    Michigan College of Optometry at Ferris State University, Big Rapids, Michigan, United States
  • Zhuokai Li
    Jaeb Center for Health Research, Tampa, Florida, United States
  • Raymond T Kraker
    Jaeb Center for Health Research, Tampa, Florida, United States
  • Jonathan M Holmes
    Ophthalmology and Vision Science, University of Arizona, Tucson, Arizona, United States
  • Susan A Cotter
    Southern California College of Optometry, Fullerton, California, United States
  • Footnotes
    Commercial Relationships   Angela Chen None; Sergul Erzurum None; Danielle Chandler None; Amra Hercinovic None; John Erickson None; Marilyn Vricella None; Benjamin Ticho None; Silvia Han None; Amy Waters None; Paula McDowell None; Zhuokai Li None; Raymond Kraker None; Jonathan Holmes None; Susan Cotter None
  • Footnotes
    Support  NEI Grant EY011751, NEI Grant EY018810, NEI Grant EY023198, NEI Grant EY024333
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3673 – A0330. doi:
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      Angela Chen, Sergul Ayse Erzurum, Danielle L Chandler, Amra Hercinovic, John W Erickson, Marilyn Vricella, Benjamin H Ticho, Silvia Han, Amy L Waters, Paula S McDowell, Zhuokai Li, Raymond T Kraker, Jonathan M Holmes, Susan A Cotter; Three-Year Change in Refractive Error Associated with Overminus Lens Treatment for Children with Intermittent Exotropia. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3673 – A0330.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : In a randomized trial comparing overminus versus non-overminus spectacles in children with intermittent exotropia (IXT), we found that overminus spectacles improved distance IXT control but also increased myopic shift at 1 year (-0.42D in 189 overminus vs -0.04D in 169 non-overminus participants, respectively; adjusted difference = -0.37D; 95% CI = -0.49 to -0.26). (Chen et al, JAMA Ophthalmol 2021;139(4):464-476) We now report refractive error change over 3 years in a post-RCT subcohort.

Methods : 386 children 3 to 10 years old with IXT and spherical equivalent (SE) refractive error between -6.00 diopters (D) and +1.00D were randomly assigned to overminus spectacles (-2.50D over cycloplegic refraction for 12 months, -1.25D for 3 months, then non-overminus for 3 months) or non-overminus spectacles for 18 months. 221 participants (124 of 196 [63%] in overminus; 97 of 190 [51%] in non-overminus) re-enrolled for 2- and 3-year follow-up, with IXT treatment at investigator discretion. Refractive error was determined by cycloplegic retinoscopy.

Results : The 3-year visit was completed by 83% (103 of 124) of participants in the overminus group and 88% (85 of 97) in the non-overminus group. Between 1 to 3 years, mean myopic shift was -0.37D in both groups (SD = 0.68 in overminus; SD = 0.67 in non-overminus). The mean overall change in refractive error from baseline to 3 years was greater in the overminus group (-0.82D) vs the non-overminus group (-0.46D; adjusted difference = -0.43D; 95% CI = -0.68 to -0.19), with 30% (30 of 101) in the overminus group vs 16% (13 of 83) of the non-overminus group having >1D of myopic shift over 3 years (risk ratio = 1.9; 95% CI = 1.0 to 3.6). Risk ratios for developing >1D of myopic shift over 3 years between overminus and non-overminus groups were 2.7 (95% CI= 1.4 to 6.0; 78% vs 29%) in 46 participants with baseline myopia (SE -0.50D to -6.00D), 2.6 (95% CI = 0.9 to 20.3; 36% vs 14%) in 58 emmetropes (SE -0.375D to +0.375D), and 1.1 (95% CI = 0.2 to 10.9; 7% vs 6%) in 78 with low hyperopia (SE +0.50D to 1.00D) at baseline.

Conclusions : While the greater myopic shift that occurred during 1 year of overminus lens treatment was still present at 3 years, the myopic shift during the 2 years after treatment cessation was similar in both groups. The risk of prolonged myopic shift should be discussed with parents when considering overminus lens treatment.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

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