title: The role of anisometropia in the development of accommodative esotropia.
abstract: OBJECTIVE
  To determine whether anisometropia increases the risk for the development of accommodative esotropia with hypermetropia.
  
  
  METHODS
  Records of all new patients with a refractive error of +2.00 D or more (mean spherical equivalent of both eyes) over a 42-month period were reviewed. Three hundred forty-five patients were thus analyzed to determine the effect of anisometropia (>or=1 D) on the relative risk of developing accommodative esotropia and of developing unsatisfactory control with spectacles once esotropia was present.
  
  
  RESULTS
  Anisometropia (>or=1 D) increased the relative risk of developing accommodative esotropia to 1.68 (P < .05). Anisometropia (>or=1 D) increased the relative risk for esotropia to 7.8 (P < .05) in patients with a mean spherical equivalent less than +3.00 D and increased it to 1.49 (P < .05) in patients with a mean spherical equivalent of +3.00 D or more (P = .016). In patients with esotropia and anisometropia (>or=1 D), the relative risk for a deviation that was unsatisfactorily controlled with spectacles was 1.72 (P < .05) compared with patients with esotropia but without anisometropia. Unsatisfactorily controlled esotropia was present in 33% of patients with anisometropia versus 0% of patients without anisometropia, with a mean hypermetropic spherical equivalent of less than +3.00 D (P = .003); however, anisometropia did not significantly increase the relative risk of unsatisfactory control of esotropia with spectacles in patients with a hypermetropic spherical equivalent of +3.00 D or more. Although amblyopia and anisometropia were closely associated, anisometropia increased the relative risk for esotropia to 2.14 (P < .05), even in the absence of amblyopia.
  
  
  CONCLUSIONS
  Anisometropia (>or=1 D) is a significant risk factor for the development of accommodative esotropia, especially in patients with lower overall hypermetropia (>+3.00 D). Anisometropia also increases the risk that an accommodative esotropia will not be satisfactorily aligned with spectacles.
authors.affiliation: Department of Ophthalmology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9057, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Weakley
authors.forename: E
authors.initials: E
authors.lastname: Birch
authors.forename: K
authors.initials: K
authors.lastname: Kip
mesh_terms: D000065:Accommodation, Ocular; D015858:Anisometropia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D002675:Child, Preschool; D003941:Diagnostic Techniques, Ophthalmological; D004948:Esotropia / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D005139:Eyeglasses; D006801:Humans; D012307:Risk Factors