In this excellent review article, the authors discuss how some hyperopes avoid strabismus but also ask why the youngest infants escape strabismus and older patients go on to decompensate. The review considers a number of related aspects and their inter-relations including: the development of accommodation, the development of vergence and the development of refractive error. The authors conclude from their review of the literature that infants have active accommodation and vergence responses established commonly by three to six months of age. However, in order to improve prevention of strabismus development, it is important to improve our understanding of how individuals manage combined accommodation and vergence motor responses and how individuals avoid development of strabismus despite presence of risk factors such as family history and refractive error.

Why do only some hyperopes become strabismic?
Babinsky E, Candy TR.
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Carmel Noonan

Aintree University Hospital, Liverpool, UK

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