Comparison of Myopia Progression among Myopic Children with Intermittent Exotropia and No Strabismus

SIGNIFICANCE Myopia is a highly prevalent condition in the pediatric population that is commonly comorbid with intermittent exotropia. Our study found a trend toward significance in the reduction of myopia progression with strabismus correction surgery. Further investigations characterizing the interaction between myopia and strabismus may help inform future management guidelines. PURPOSE This study describes and compares myopic progression in the pediatric population with and without intermittent exotropia and its interaction with corrective strabismus surgery. METHODS This study analyzed a retrospective cohort of 1239 pediatric myopic patients who were evaluated by pediatric ophthalmologists and optometrists at a tertiary care center from 2012 to 2020. The main outcome measures were the trends in refractive error over time in those with and without intermittent exotropia as well as trends in those who did and did not undergo strabismus surgery. RESULTS A total of 275 patients (22%) were identified to have intermittent exotropia, and 12 (4.4%) from this group underwent surgical correction in the study period. No statistically significant difference was identified in myopic progression between those with intermittent exotropia and those without strabismus, and no difference was found in mean annual spherical equivalent change between intermittent exotropia patients who did not undergo surgery compared with those who did. CONCLUSIONS Pediatric myopic patients generally experience progression in the condition for several years independent of concurrent intermittent exotropia. Corrective strabismus surgery was not found to alter the natural history of myopia in children, although a reduction in myopic progression in surgically treated patients trended toward significance. Increases in the prevalence of different treatment strategies will necessitate further studies to determine best practices for this population.