Acta Scientific Ophthalmology (ISSN: 2582-3191)

Research Article Volume 6 Issue 6

A-V Pattern Strabismus

Shamit Pal 1*, Om Shankar Kamat2 and Pratibha Yadav3

1,2Assistant Professor at Maharishi Markandeshwar University and Medical College, India
3Senior Consultant Optometrist at Lal Eye Care 20/20

*Corresponding Author: Shamit Pal, Assistant Professor, at Maharishi Markandeshwar University and Medical College, India.

Received: November 09, 2021; Published: May 26, 2023


Alphabetic pattern strabismus, of which the most common example are A and V pattern horizontal deviations, has gained a lot of importance during the last few decades. The emphasis on this important subject is not only due to the fact that it is a common condition when one is on the lookout for it, but also that it is much more difficult to manage than are cases of comitant horizontal deviations. While the only effective treatment is surgery, routine surgery often fails and special surgical procedures have to be used.

A or V patterns occur when the relative contribution of the superior rectus and inferior oblique to elevation or of the inferior rectus and superior oblique depression are abnormal resulting in derangement of the balance of their horizontal vector in up and downgaze. They can also be caused by anomalies in the position of the rectus pulleys. Assessment is by measuring horizontal deviation in the primary position upgaze and downgaze. They can occur in both concomitant and incomitant deviation.

An A or V pattern is found in 15-25% of horizontal strabismus cases. An A- pattern is present when a horizontal deviation shows a more convergent (less divergent) alignment in upward gaze compared with down gaze. V- pattern describes a horizontal deviation that is more convergent (less divergent) in down gaze compared with up gaze.

Uretts-Zavatia in 1948 was the first to emphasize importance of measuring angle of deviation in cases of strabismus in the straight upward and downward positions of gaze in addition to the usual measurements in the primary straight-ahead position. In 1957, Albert suggested the excellent descriptive patterns of A-pattern and V- pattern.

 Keywords: Deviation; A-Pattern; V-Pattern


  1. Prakash P., et al. “Surgical management of A and V patterns”. Indian Journal of Ophthalmology 31 (1983): 463-469.
  2. Knapp P. “Vertically incomitant horizontal strabismus, the so called A and V syndromes”. Transactions of the American Ophthalmological Society 57 (1959): 666.
  3. Miller JE. “Vertical recti transplantation in the A and V syndromes”. Archives of Ophthalmology 64 (1960): 175.
  4. Jack J. “Kanski, Clinical Ophthalmology”. 6th Butterworth-Heinemann (2007).
  5. Kenneth W Wright., et al. “Handbook of Paediatric strabismus and amblyopia”. Springer (2006).
  6. Sharma P., et al. “Effect of monocular vertical displacement of horizontal recti in A V phenomena”. Indian Journal of Ophthalmology 43 (1955): 9-11.
  7. Noorden GK von and Olson CL. “Diagnosis and surgical management of vertically incomitant horizontal strabismus”. American Journal of Ophthalmology 60 (1965): 433-442.
  8. Paediatric ophthalmology and strabismus, American academy of ophthalmology (2008-2009).


Citation: Shamit Pal., et al. “A-V Pattern Strabismus".Acta Scientific Ophthalmology 6.6 (2023): 10-13.


Copyright: © 2023 Shamit Pal., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate35%
Acceptance to publication20-30 days
ISI- IF1.042
JCR- IF0.24

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