Pseudomyopia in intermittent exodeviation: comment.

Dear Editor,

We have read with great interest an article by Jayakumar et al., on Pseudomyopia in intermittent exodeviation.[1] The authors have described a young patient with intermittent exodeviation (IXT) who was operated for bilateral lateral rectus weakening and thereafter diagnosed as a case of pseudomyopia which was well managed with cycloplegics.

We commend the authors for addressing a very important problem in strabismology practice and would like to add a few comments.

Large exophoria or intermittent exotropia has been described as an aetiological factor for accommodative spasm.[2] We agree with the authors that patients with IXT could make use of accommodative convergence to control the exodeviation, thereby resulting in accommodative spasm over a period of time.

We have recently published our experience with diagnosis and role of vision therapy exercises in a young patient with accommodative spasm secondary to long standing intermittent exotropia.[3] In contrast to the patient described by Jayakumar M, our patient presented with severe asthenopic symptoms, an intractable spasm of accommodation, high pseudomyopia, and a variable angle of deviation. It was only after management with cycloplegia and normalizing the accommodative amplitudes by vision therapy exercises that IXT as the aetiology was diagnosed; there was complete resolution of symptoms after squint surgery.

We also agree with the authors that post-surgery residual angle could lead to persistence of pseudomyopia. In this group of patients, we therefore undertake a prolonged prism adaptation to uncover the full amount of deviation before planning surgery.

We appreciate the authors’ effort to make the ophthalmologists aware of occurrence of pseudomyopia in patients with IXT. Since the presentation in such cases may be myriad, a detailed orthoptic evaluation is warranted to reach a proper diagnosis. We would also like to emphasize the role of vision therapy exercises to normalize the accommodative amplitude as an important adjunct in management of such cases.