Longitudinal Development of Refractive Error in Children With Accommodative Esotropia: Onset, Amblyopia, and Anisometropia.
OBJECTIVE
We investigated longitudinal changes of refractive error in children with accommodative esotropia (ET) throughout the first 12 years of life, its dependence on age at onset of ET, and whether amblyopia or anisometropia are associated with defective emmetropization.


METHODS
Longitudinal refractive errors in children with accommodative ET were analyzed retrospectively. Eligibility criteria included: initial hyperopia ≥ +4.00 diopters (D), initial cycloplegic refraction before 4 years, at least 3 visits, and at least one visit between 7 and 12 years. Children were classified as having infantile (N = 30; onset ≤ 12 months) or late-onset (N = 78; onset at 18-48 months) accommodative ET. Cycloplegic refractions culled from medical records were converted into spherical equivalent (SEQ).


RESULTS
Although the initial visit right eye SEQ was similar for the infantile and late-onset groups (+5.86 ± 1.28 and +5.67 ± 1.26 D, respectively), there were different developmental changes in refractive error. Neither group had a significant decrease in hyperopia before age 7 years, but after 7 years, the infantile group experienced a myopic shift of -0.43 D/y. The late-onset group did not experience a myopic shift at 7 to 12 years. Among amblyopic children, a slower myopic shift was observed for the amblyopic eye. Among anisometropic children, the more hyperopic eye experienced more myopic shift than the less hyperopic eye.


CONCLUSIONS
Children with infantile accommodative ET experienced prolonged hyperopia followed by a myopic shift after 7 years of age, consistent with dissociation between infantile emmetropization and school age myopic shift. In contrast, children with late-onset accommodative ET had little myopic shift before or after 7 years.
Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania, United States 2Glick Eye Institute, Indiana University School of Medicine, Indianapolis, Indiana, United States.
Jingyun
J
Wang
Retina Foundation of the Southwest, Dallas, Texas, United States.
Sarah E
SE
Morale
Department of Biostatistics, School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States.
Xiaowei
X
Ren
Retina Foundation of the Southwest, Dallas, Texas, United States 5Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, United States.
Eileen E
EE
Birch
D017668:Age of Onset; D000550:Amblyopia / Q000150:complications*; D015858:Anisometropia / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D004948:Esotropia / Q000209:etiology* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012031:Refractometry; D012189:Retrospective Studies; D014792:Visual Acuity