title: Strabismus surgery for elimination of bifocals in accommodative esotropia.
abstract: OBJECTIVE
  This study reports the outcomes of strabismus surgery to eliminate bifocals in patients with accommodative esotropia with a high accommodative convergence to accommodation (AC:A) ratio.
  
  
  METHODS
  Retrospective interventional case series.
  
  
  METHODS
  Sixteen patients who wore bifocals for treatment of accommodative esotropia with a high AC:A ratio underwent strabismus surgery following prism adaptation testing (PAT) for the near angle of esotropia without bifocals. Outcomes were considered successful if patients had microtropias and maintained fusion without bifocals.
  
  
  RESULTS
  All patients had successful outcomes after one or two surgeries. Three of 13 (23%) patients with positive PATs required two surgeries. Two of three (67%) patients with negative PATs required two surgeries. Binocularity remained the same in 13 patients and improved in three patients. Glasses were eliminated entirely in eight of 16 (50%) patients.
  
  
  CONCLUSIONS
  Strabismus surgery may eliminate the need for bifocal glasses in patients with accommodative esotropia with a high AC:A ratio, with many patients able to discontinue glasses entirely. Preoperative PAT may help predict the risk of requiring more than one surgery.
authors.affiliation: Department of Ophthalmology and Visual Sciences and Pediatrics, St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO 63110, USA. lueder@vision.wustl.edu
authors.forename: Gregg T
authors.initials: GT
authors.lastname: Lueder
authors.forename: Alan A
authors.initials: AA
authors.lastname: Norman
mesh_terms: D000065:Accommodation, Ocular; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003290:Convergence, Ocular / Q000502:physiology; D004948:Esotropia / Q000503:physiopathology / Q000601:surgery*; D005139:Eyeglasses; D005260:Female; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology