Korean J Ophthalmol.  2014 Oct;28(5):417-422. 10.3341/kjo.2014.28.5.417.

Accommodative Esotropia Who Needs Spectacles for Good Ocular Alignment after Refractive Shift below +2.00 Diopters

• Kim WJ
• Kim MM

• KMID: 2344266
• DOI: http://doi.org/10.3341/kjo.2014.28.5.417

Abstract

PURPOSE
The aim of this study is to investigate the clinical characteristics of patients diagnosed with refractive accommodative esotropia (RAE) whose refractive errors were gradually reduced to below +2.00 diopters (D) during follow-up but use of spectacles was still required for maintenance of good ocular alignment.
METHODS
We conducted a retrospective review of the medical records of patients diagnosed with RAE from 1995 to 2011. Patients were divided into 2 groups according to their ocular alignment at the last visit. Inclusion criteria were hyperopia > or =+2.00 D detected with cycloplegic refraction at the initial visit, which then became mild hyperopia (<+2.00 D) or myopia during follow-up, with more than 5 years of follow-up.
RESULTS
A total of 92 patients met the inclusion criteria. Twenty-six patients showed persistent esotropia (> or =10 prism diopters [PD]) without spectacles (group A) and 66 patients showed good ocular alignment (<10 PD) without spectacles (group B) at the last visit. No statistically significant differences in the spherical equivalent of the refractive errors at the initial and last visit were observed between the two groups. A significantly lower number of positive responses on the Lang I stereotest was observed in group A (n = 1, 3.8%) compared to group B (n = 22, 33.3%) (p = 0.003). There were increasing trends toward group A with worsening stereoacuity measured by the Stereo Fly Stereotest between the two groups (p = 0.016, linear by linear association). The results of the Lang I test, Stereo Fly Stereotest, and duration between the onset of esotropia and prescribing spectacles showed a significant association with the discontinuation of spectacles in the univariate logistic analysis.
CONCLUSIONS
Stereoacuity showed more significant associations than refractive errors in RAE with refractive error <+2.00 D but still required spectacles for maintenance of good ocular alignment. The prompt treatment of accommodative esotropia at the onset of esotropia is important for the discontinuation of spectacles.

Keyword

Esotropia; Eyeglasses; Hyperopia

MeSH Terms

Accommodation, Ocular/physiology
Adult
Aged
Esotropia/*physiopathology
*Eyeglasses
Female
Follow-Up Studies
Humans
Hyperopia/physiopathology/*therapy
Male
Middle Aged
Refraction, Ocular/physiology
Retrospective Studies
Vision, Binocular/*physiology
Visual Acuity/physiology

Reference

1. Mohney BG, Lilley CC, Green-Simms AE, Diehl NN. The long-term follow-up of accommodative esotropia in a population-based cohort of children. Ophthalmology. 2011; 118:581–585.

2. Mohney BG. Common forms of childhood esotropia. Ophthalmology. 2001; 108:805–809.

3. Chia A, Roy L, Seenyen L. Comitant horizontal strabismus: an Asian perspective. Br J Ophthalmol. 2007; 91:1337–1340.

4. Black BC. The influence of refractive error management on the natural history and treatment outcome of accommodative esotropia (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2006; 104:303–321.

5. Rutstein RP. Update on accommodative esotropia. Optometry. 2008; 79:422–431.

6. Lambert SR, Lynn M, Sramek J, Hutcheson KA. Clinical features predictive of successfully weaning from spectacles those children with accommodative esotropia. J AAPOS. 2003; 7:7–13.

7. Demirkilinc Biler E, Uretmen O, Kose S. The effect of optical correction on refractive development in children with accommodative esotropia. J AAPOS. 2010; 14:305–310.

8. Berk AT, Kocak N, Ellidokuz H. Treatment outcomes in refractive accommodative esotropia. J AAPOS. 2004; 8:384–388.

9. Park KA, Kim SA, Oh SY. Long-term changes in refractive error in patients with accommodative esotropia. Ophthalmology. 2010; 117:2196–2207.

10. Mulvihill A, MacCann A, Flitcroft I, O'Keefe M. Outcome in refractive accommodative esotropia. Br J Ophthalmol. 2000; 84:746–749.

11. Lambert SR, Lynn MJ. Longitudinal changes in the spherical equivalent refractive error of children with accommodative esotropia. Br J Ophthalmol. 2006; 90:357–361.

12. Choi DK, Choi MY. Clinical manifestation of patients with accommodative esotropia for 10 years. J Korean Ophthalmol Soc. 2011; 52:1331–1336.

13. Kim MM, Rim BK. The methods of atropinization for cycloplegic refraction in esotropic children. J Korean Ophthalmol Soc. 1993; 34:246–251.

14. Chang JH, Kim MM. Refractive accommodative esotropia associated with mild hyperopia. J Korean Ophthalmol Soc. 2005; 46:1547–1554.

15. Hutcheson KA, Ellish NJ, Lambert SR. Weaning children with accommodative esotropia out of spectacles: a pilot study. Br J Ophthalmol. 2003; 87:4–7.