Interocular difference associated with myopic progression following unilateral lateral rectus recession in early school-aged children

  • Yooyeon Park
  • Ye Jin Ahn
  • Shin Hae Park
  • Sun Young ShinEmail author
Clinical Investigation



To compare refractive changes in operated eyes and fellow unoperated eyes following unilateral lateral rectus recession in early school-aged children.

Study design

A retrospective case control study.


The medical records of children under ten years of age with intermittent exotropia who underwent unilateral lateral recession surgery were reviewed. The operated eyes were reviewed and the fellow unoperated eyes were used as control. The rate of myopic progression was calculated by spherical equivalent (SE) changes per year, and by the rate of refractive growth (RRG) equation.


SE showed a myopic shift one week after surgery and in the following months, from -1.43 ± 1.84 diopters (D) at 1 week post operation to -1.57 ± 2.22 D at one year and, finally -2.95 ± 2.97 D at the average 4.62 years following surgery. However, the SE shift was not significantly different from the unoperated eye. The low myopia group (under -3.0 D) showed a significantly higher myopic change in the operated eye until one year post operation (p = 0.022). The average myopic shift ratio was -0.53 ± 0.46 D yearly in the operated eye.


This study presents data of a large series of refractive changes secondary to lateral rectus recession, and of long-term myopia progression in Korean population.


Unilateral lateral rectus recession Intermittent exotropia Rate of myopic progression Early school-aged children 



There is no competing interest for any of the authors. This study was supported by the Catholic Medical Center Research Foundation made in the program year of 2018. Design of the study (Y.P., S.H.P., S.Y.S.), collection of the data (Y.P. and Y.J.A.), management and analysis of the data (Y.P.), interpretation of the data (Y.P. and S.Y.S.), writing of the article (Y.P. and Y.J.A.), approval of the manuscript (Y.P., S.H.P., S.Y.S.), obtaining of funding (S.Y.S.), searching the literature (Y.P.).

Conflicts of interest

Y. Park, None; Y. J. Ahn, None; S. H. Park, None; S. Y. Shin, None.


  1. 1.
    Rajavi Z, Mohammad Rabei H, Ramezani A, Heidari A, Daneshvar F. Refractive effect of the horizontal rectus muscle recession. Int ophthalmol. 2008;28:83–8.CrossRefGoogle Scholar
  2. 2.
    Hong SW, Kang NY. Astigmatic changes after horizontal rectus muscle surgery in intermittent exotropia. Korean J Ophthalmol. 2012;26:438–45.CrossRefGoogle Scholar
  3. 3.
    Noh JH, Park KH, Lee JY, Jung MS, Kim SY. Changes in refractive error and anterior segment parameters after isolated lateral rectus muscle recession. J AAPOS. 2013;17:291–5.CrossRefGoogle Scholar
  4. 4.
    Shin KH, Hyun SH, Kim IN, Paik HJ. The impact of intermittent exotropia and surgery for intermittent exotropia on myopic progression among early school-aged children with myopia. Br J Ophthalmol. 2014;98:1250–4.CrossRefGoogle Scholar
  5. 5.
    Leshno A, Mezad-Koursh D, Ziv-Baran T, Stolovitch C. A paired comparison study on refractive changes after strabismus surgery. J AAPOS. 2017;21(460–2):e1.Google Scholar
  6. 6.
    Bae SH, Choi DG. Changes of corneal topographic measurements and higher-order aberrations after surgery for exotropia. PLoS One. 2018;13:e0202864.CrossRefGoogle Scholar
  7. 7.
    Christensen AM, Wallman J. Evidence that increased scleral growth underlies visual deprivation myopia in chicks. Investig Ophthalmol Vis Sci. 1991;32:2143–50.Google Scholar
  8. 8.
    Smith EL 3rd. Spectacle lenses and emmetropization: the role of optical defocus in regulating ocular development. Optometry Vis Sci. 1998;75:388–98.CrossRefGoogle Scholar
  9. 9.
    Horwood AM, Riddell PM. Evidence that convergence rather than accommodation controls intermittent distance exotropia. Acta Ophthalmol. 2012;90:e109–17.CrossRefGoogle Scholar
  10. 10.
    Ekdawi NS, Nusz KJ, Diehl NN, Mohney BG. The development of myopia among children with intermittent exotropia. Am J Ophthalmol. 2010;149:503–7.CrossRefGoogle Scholar
  11. 11.
    Gwiazda J, Thorn F. Development of refraction and strabismus. Curr Opin Ophthalmol. 1998;9:3–9.CrossRefGoogle Scholar
  12. 12.
    McClatchey SK, Hofmeister EM. The optics of aphakic and pseudophakic eyes in childhood. Surv Ophthalmol. 2010;55:174–82.CrossRefGoogle Scholar
  13. 13.
    Bagheri A, Farahi A, Guyton DL. Astigmatism induced by simultaneous recession of both horizontal rectus muscles. J AAPOS. 2003;7:42–6.CrossRefGoogle Scholar
  14. 14.
    Preslan MW, Cioffi G, Min YI. Refractive error changes following strabismus surgery. J Pediatric Ophthalmol Strabismus. 1992;29:300–4.Google Scholar
  15. 15.
    Schaeffel F, Glasser A, Howland HC. Accommodation, refractive error and eye growth in chickens. Vis Res. 1988;28:639–57.CrossRefGoogle Scholar
  16. 16.
    Irving EL, Sivak JG, Callender MG. Refractive plasticity of the developing chick eye. Ophthalmic Physiol Opt. 1992;12:448–56.CrossRefGoogle Scholar
  17. 17.
    Smith EL 3rd, Hung LF. The role of optical defocus in regulating refractive development in infant monkeys. Vis Res. 1999;39:1415–35.CrossRefGoogle Scholar
  18. 18.
    Wallman J, Adams JI. Developmental aspects of experimental myopia in chicks: susceptibility, recovery and relation to emmetropization. Vis Res. 1987;27:1139–63.CrossRefGoogle Scholar
  19. 19.
    Wildsoet CF. Active emmetropization–evidence for its existence and ramifications for clinical practice. Ophthalmic Physiol Opt. 1997;17:279–90.CrossRefGoogle Scholar
  20. 20.
    Suzuki H, Hikoya A, Komori M, Inagaki R, Haseoka T, Arai S, et al. Changes in conjunctival-scleral thickness after strabismus surgery measured with anterior segment optical coherence tomography. Jpn J Ophthalmol. 2018;62:554–9.CrossRefGoogle Scholar
  21. 21.
    Wong HB, Machin D, Tan SB, Wong TY, Saw SM. Ocular component growth curves among Singaporean children with different refractive error status. Investig Ophthalmol Vis Sci. 2010;51:1341–7.CrossRefGoogle Scholar
  22. 22.
    Jones LA, Mitchell GL, Mutti DO, Hayes JR, Moeschberger ML, Zadnik K. Comparison of ocular component growth curves among refractive error groups in children. Investig Ophthalmol Vis Sci. 2005;46:2317–27.CrossRefGoogle Scholar
  23. 23.
    Lam CS, Edwards M, Millodot M, Goh WS. A 2-year longitudinal study of myopia progression and optical component changes among Hong Kong schoolchildren. Optometry Vis Sci. 1999;76:370–80.CrossRefGoogle Scholar
  24. 24.
    Shih YF, Chiang TH, Hsiao CK, Chen CJ, Hung PT, Lin LL. Comparing myopic progression of urban and rural Taiwanese schoolchildren. Jpn J Ophthalmol. 2010;54:446–51.CrossRefGoogle Scholar
  25. 25.
    Saw SM, Nieto FJ, Katz J, Schein OD, Levy B, Chew SJ. Factors related to the progression of myopia in Singaporean children. Optometry Vis Sci. 2000;77:549–54.CrossRefGoogle Scholar
  26. 26.
    Kwitko S, Feldon S, McDonnell PJ. Corneal topographic changes following strabismus surgery in Grave’s disease. Cornea. 1992;11:36–40.CrossRefGoogle Scholar
  27. 27.
    Asejczyk-Widlicka M, Pierscionek BK. The elasticity and rigidity of the outer coats of the eye. Br J Ophthalmol. 2008;92:1415–8.CrossRefGoogle Scholar
  28. 28.
    Dottan SA, Hoffman P, Oliver MD. Astigmatism after strabismus surgery. Ophthalmic Surg. 1988;19:128–9.PubMedGoogle Scholar

Copyright information

© Japanese Ophthalmological Society 2019

Authors and Affiliations

  • Yooyeon Park
    • 1
  • Ye Jin Ahn
    • 1
  • Shin Hae Park
    • 1
  • Sun Young Shin
    • 1
    Email author
  1. 1.Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary’s HospitalThe Catholic University of KoreaSeoulRepublic of Korea

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