title: The role of anisometropia in the development of accommodative esotropia.
abstract: OBJECTIVE
  To determine if anisometropia increases the risk for the development of accommodative esotropia in hypermetropia.
  
  
  METHODS
  Records of all new patients with a refractive error of > or = +2.00 (mean spherical equivalent [SE] of both eyes) over a 42-month period were reviewed. Three hundred forty-five (345) patients were thus analyzed to determine the effect of anisometropia (> or = 1 diopter [D]) on the relative risk of developing esodeviation and of requiring surgical correction once esodeviation was present (uncontrolled deviation).
  
  
  RESULTS
  Anisometropia (> or = 1 D) increased the relative risk of developing accommodative esodeviation to 1.68 (P < .05). Anisometropia (> or = 1 D) increased the relative risk for esodeviation to 7.8 (P < .05) in patients with a mean SE of < 3 D and to 1.49 (P < .05) in patients with SE of > or = 3 D. This difference was significant (P = .016). In patients with esotropia and anisometropia (> or = 1 D), the relative risk for an uncontrolled deviation was 1.72 (P < .05) compared with nonanisometropic esotropic patients. Uncontrolled esodeviation was present in 33% of anisometropic patients versus 0% of nonanisometropic patients with a mean hypermetropic SE of < 3 D (P = .003); however, anisometropia did not increase the relative risk of uncontrolled esotropia in patients with SE of > or = 3 D. Although amblyopia and anisometropia were closely associated, anisometropia increased the relative risk of esodeviation to 2.14 (P < .05) even in the absence of amblyopia.
  
  
  CONCLUSIONS
  Anisometropia (> 1 D) is a significant risk factor for the development of accommodative esodeviation, especially in patients with lower overall hypermetropia (< 3 D). Anisometropia also increases the risk that an accommodative esodeviation will not be fully eliminated with hypermetropic correction.
authors.affiliation: Department of Ophthalmology, University of Texas Southwestern Medical Center at Dallas, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Weakley
authors.forename: E
authors.initials: E
authors.lastname: Birch
mesh_terms: D000065:Accommodation, Ocular; D000550:Amblyopia / Q000150:complications; D015858:Anisometropia / Q000150:complications* / Q000503:physiopathology; D002675:Child, Preschool; D004948:Esotropia / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D006956:Hyperopia / Q000150:complications / Q000503:physiopathology; D012030:Refractive Errors / Q000150:complications; D012307:Risk Factors