The purpose of this systematic review was to evaluate the management strategies and outcomes for hypermetropic patients with exotropia, and to determine implications of refractive correction decisions in optimising clinical outcomes. 10 studies met the inclusion criteria from 6 countries with a total of 1090 subjects of which 194 were hypermetropic. Mean age was 8.1 years (SD 2.24). Hypermetropic ranged from +0.50 to +10D. Eight studies reported undercorrection of hypermetropia by 1 to 2.5D. Three gave full correction for hypermetropic patients >5D. Undercorrection was found to be effective in improving control of exotropia in 8 studies. 2 studies found full correction to alter the deviation from exotropia to esotropia or vice versa. Postoperative success rates were higher in hypermetropic patients than emmetropia. Generally, for low hypermetropia, overminus lenses or undercorrection often yielded good outcomes. Moderate hypermetropia of 3-5D needed prescription trials to determine the most effective approach. High hypermetropia >5D had a recommendation of full correction alongside close observation. This was particularly relevant for those with low AC/A ratio. Surgical management options and non-surgical options were shown to improve sensory and motor outcomes in hypermetropic patients with exotropia.
Decisions on correction of low, moderate and high hypermetropic in exotropia
Reviewed by Fiona Rowe
Management and outcomes of exotropia in hyperopic patients: systematic review.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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