The influence of refractive error management on the natural history and treatment outcome of accommodative esotropia (an American Ophthalmological Society thesis).
OBJECTIVE
To evaluate the effect of refractive error management on resolution of accommodative esotropia, deterioration of accommodative esotropia, and the natural history of hypermetropia in accommodative esotropia.


METHODS
Retrospective cohort study and nested case-control study of patients with accommodative esotropia untreated prior to diagnosis by the author. Eligibility criteria included esodeviation of >/=10 prism diopters (PD) on distance and near fixation on initial examination, hypermetropia, distance esodeviation <10 PD with full cycloplegic refraction correction on first follow-up examination, and at least 2 years of follow-up.


RESULTS
The study included 285 patients with mean follow-up of 102 months. After age 7 years, mean annual decrease in hypermetropia was .24 D for patients wearing full cycloplegic refraction and for patients in whom hypermetropia was undercorrected by 1.00 D or more. Age at diagnosis (P < .0001), oblique muscle dysfunction (P < .0001), and abnormal distance-near relationship (P = .007) were associated with deterioration of accommodative esotropia. Of 51 patients with an intermittent abnormal distance-near relationship, 19 (37%) had increased hypermetropia on cycloplegic refraction, and prescription of the increased correction normalized the distance-near relationship.


CONCLUSIONS
The possibility that undercorrecting hypermetropia speeds its resolution is not supported by this study. Accommodative esotropia is usually stable, but younger age at diagnosis, oblique muscle dysfunction, and abnormal distance-near relationship are associated with deterioration. Undercorrection of hypermetropia can cause an abnormal distance-near relationship, which in turn can cause deterioration of accommodative esotropia. Aggressive undercorrection of hypermetropia should be pursued carefully, because the risk may outweigh the potential advantages.
Black
Bradley Charles
BC
Department of Ophthalmology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA.
D000065:Accommodation, Ocular; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004948:Esotropia / Q000503:physiopathology*; D005139:Eyeglasses; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006956:Hyperopia / Q000503:physiopathology* / Q000628:therapy*; D007223:Infant; D008297:Male; D009801:Oculomotor Muscles / Q000503:physiopathology*; D012029:Refraction, Ocular; D012189:Retrospective Studies; D014792:Visual Acuity