Spontaneous consecutive exotropia after conservative management of accommodative esotropia

@#Spontaneous consecutive exotropia (SCXT) in conservatively managed accommodative esotropia is not widely discussed. The author presents a case series of 4 patients with SCXT describing patient characteristics and possible risk factors. Management modifications based on this series are proposed. Four cases of patients who initially presented with accommodative esotropia and later developed SCXT are presented. The age range at presentation was between 4 months to 3 years, with total follow-up ranging between 8–15 years. All four cases presented with esotropia on or before the age of 3 years, with initial hyperopia ranging between +1.50 to +4.25. The SCXT occurred between ages 2–7 years. Possible risk factors identified include amblyopia, dissociated vertical deviation, rapid control of esodeviation, inferior oblique overaction, and poor follow-up during the course of their strabismus. The author recommends earlier tapering of hyperopia correction following initial control with full cycloplegic refraction. Identified risk factors should alert the specialists to be wary of SCXT.

Long-Term Binocularity in Accommodative Esotropia

PURPOSE: To find clinical factors related to the long-term outcome of binocularity in accommodative esotropia. METHODS: Forty-nine patients with accommodative esotropia who were followed over 5 years after successful optical alignment within 8 prism diopters of orthophoria at near and distance with glasses including bifocals were included. The patients who had stereo acuity better than 50 seconds/arc and central fusion without suppression scotoma at the final visit were divided into the bifoveal fusion group and the others were divided into the peripheral fusion group. Clinical factors were analyzed between the two groups (Chi-square test, student t-test). RESULTS: Of the 49 patients, 15 patients were included in the bifoveal fusion group and 34 patients were included in peripheral fusion group. Mean follow-up was 88.9 +/- 25.4 months. Clinical factors that were significantly related to the bifoveal fusion group were older age of onset, shorter duration of misalignment, intermittent esotropia at the initial visit and after initial optical correction, smaller residual deviations at distance after initial optical correction and at the final visit, and lesser amblyopia. CONCLUSIONS: To obtain better levels of long-term binocularity, optical correction should be done as early as possible, before the presence of constant eye misalignment or amblyopia, and the residual esodeviations after optical correction should be kept as small as possible.

Refractive Accommodative Esotropia: Duration between Wearing Hyperopic Glasses and Control of Esotropia within 8 PD

PURPOSE: To report clinical aspects of children diagnosed with refractive accommodative esotropia after wearing their first glasses to correct hyperopia accompanied with esodeviation. METHODS: The present study included 75 children followed up for at least 24 months. Age, spherical equivalent of refractive error, angle of deviation and presence of amblyopia were analyzed according to the duration between first wearing glasses and control of esotropia within 8 PD (2 months). RESULTS: The mean age was 4.48 +/- 2.08 years and mean follow-up was 50.17 months. Initial deviation angle without glasses was 25.43 +/- 10.07 PD at far, 27.72 +/- 11.45 PD at near, spherical equivalent was +4.86 +/- 2.41 D in right eyes, +5.05 +/- 1.06 D in left eyes and 8 of 75 patients (10.67%) had 2 months had less hyperopia (+4.02 D vs. 5.17 D), more severe esodeviation both at far (30.79 +/- 10.79 PD vs. 24.17 +/- 9.56 PD, p = 0.03) and at near distance (34.00 +/- 14.20 PD vs. 26.25 +/- 10.31 PD, p = 0.02) and higher initial amblyopia prevalence rates (71.5% vs. 47.5%). CONCLUSIONS: Several patients needed longer follow-up until esotropia was controlled within 8 PD after wearing hyperopic glasses considering the amount of hyperopia and angle of esodeviation.

Short-Term Clinical Results of Hyperopic LASEK in Korean Patients

PURPOSE: To evaluate short-term clinical outcomes following hyperopic laser-assisted subepithelial keratomileusis (LASEK) in Korean patients. METHODS: This retrospective study included 18 eyes of 10 patients who underwent hyperopic LASEK between May 2005 and March 2013 in Seoul National University Hospital. Visual acuity and spherical equivalent were evaluated preoperatively and at 1 and 3 months postoperatively. High order aberrations and contrast sensitivity were measured before and 3 months after the operation. Alternative prism cover test (APCT) was performed both preoperatively with correction and postoperatively without correction. RESULTS: The mean age of patients was 32 +/- 11 years and the mean spherical equivalent refractive error was -2.95 +/- 1.24 diopters (D). Uncorrected visual acuities were log MAR +0.17 +/- 0.15 and log MAR +0.14 +/- 0.15 at postoperative 1 month and 3 months, respectively and showed no significant difference in best corrected visual acuity (+0.25 +/- 0.30). Spherical equivalent was -0.22 +/- 1.22 D at 1 month and 0.38 +/- 0.91 D at 3 months postoperatively. In 6 patients who had esotropia before the operation, APCT was 7.83 +/- 3.60 prism diopters (PD) esotropia at distance with correction preoperatively and 4.67 +/- 5.65 PD at distance without correction postoperatively. Three patients (16.7%) showed delayed wound healing with 1 (5.56 %) having persistent corneal opacity without significant visual loss. CONCLUSIONS: The effect of LASEK may be comparable for correcting hyperopia and esotropia when compared with the effect of LASIK in previous reports; however, delayed wound healing may be a concern.

Clinical Characteristics of Exodeviated Patients with Accomodative Esotropia and Hyperopia without Strabismus

PURPOSE: To evaluate the clinical characteristics of exodeviated patients with accomodative esotropia and orthophoric hyperopia. METHODS: We conducted a retrospective chart review of patients with accommodative esotropia and hyperopia who later developed exotropia and visited the Department of Ophthalmology of Wonju Severance Christian Hospital from January 1, 1997 to December 31, 2013. RESULTS: The study included 13 patients with a mean age of 4.1 years at initial referral. At the initial visit, nine patients (69.2%) had accommodative esotropia with a median of 25.5 PD esotropia at near gaze. Among the esotropic patients, four patients (44.4%) had unilateral amblyopia and five patients (55.6%) had bilateral amblyopia. The spherical equivalent was +6.09 D in the amblyopic eye and +5.63 D in the dominant eye. In the cases of bilateral amblyopia, the spherical equivalent was +5.875 D. Spontaneous consecutive exotropia developed at a mean age of 8.63 years (average follow-up of 56.38 months). Mean exodeviation was 10.33 PD. Among the four patients (30.8%) who were orthophoric at their initial visit, two patients (50%) had unilateral amblyopia and two (50%) had bilateral amblyopia. The spherical equivalents of the amblyopic eye and the dominant eye were +5.63 D and +3.13 D, respectively. In cases of bilateral amblyopia, a mean spherical equivalent of +5.50 D was observed. The mean age when exodeviation occurred was 10.75 years, which was 64 months after the initial visit. The average exodeviation was 6.5 PD. CONCLUSIONS: When treating accommodative esotropia and hyperopia, long-term observation is necessary since exodeviation could develop. Exotropia was successfully managed with spectacle correction. Further studies are needed for possible surgical intervention.

Long-Term Changes of Hyperopic Refractive Error in Refractive Accommodative Esotropia

PURPOSE: To analyze the long-term changes of hyperopic refractive error in patients with refractive accommodative esotropia. METHODS: We retrospectively reviewed the medical records of 54 patients with accommodative esotropia who underwent at least 36 months of follow-up and had hyperopia more than +1.50 diopter (D). The patients were divided into groups according to the degree of hyperopia: +1.50~ or =+3.00~ or =+5.00 D, the age of their first hyperopic glasses prescription: under two-years old, between two to four-years old and older than four years old, whether or not they had amblyopia, the degree of astigmatism: or =0.75- or =1.25 D and divided into two groups according to the degree of stereopsis: 400 sec. The divided groups were than retrospectively reviewed if they influenced the refractive error at the third year of follow-up using Fisher's exact test, paired t-test, Wilcoxon's signed-ranks test, Mann-Whitney U test, Kruskal-Wallis H test, and ANOVA (p < 0.05). RESULTS: The mean follow-up period was 103.72 +/- 41.82 months for refractive accommodative esotropia. Patients with a greater initial hyperopic refractive err or showed a significant tendency towards emmetropization with a higher rate of hyperopic decrease (p < 0.001), regardless of the hyperopic refractive error. Statistical differences were not observed in patients who started wearing glasses after four-years old, patients with amblyopia, patients with a large degree of astigmatism, and patients with poor stereoacuity. CONCLUSIONS: Long-term changes of hyperopic refractive error in accommodative esotropia showed a significant decrease when initial hyperopic refractive error was high. Wearing hyperopic glasses at an older age and visual functions such as amblyopia, large degree of astigmatism, and poor stereoacuity may influence emmetropization.

Changes in Hypermetropic Spectacle Correction after Surgery in Partially Accommodative Esotropia

PURPOSE: To investigate the characteristics of successfully weaning patients off of glasses and the change in hypermetropic spectacle correction required for maintaining orthotropia using an analysis of surgery results of patients with partially accommodative esotropia. METHODS: We reviewed the medical records of 104 patients who underwent standard surgery for correcting partially accommodative esotropia. In total, 64 patients who had follow-up periods of at least 2 years were included. The patients were divided into 2 groups: 28 patients who were asked to discontinue their hyperopic glasses (glasses-discontinued group) and 36 patients who still needed hyperopic glasses (glasses-maintained group). We investigated the age at first visit and at surgery, total angle of deviation and residual angle of deviation with correction before surgery, weaning time of hyperopic glasses, follow-up period, and the time at which the hyperopic glasses were discontinued in the glasses-discontinued group. RESULTS: There were no statistically significant differences in the age at first visit and at surgery as well as the duration of postoperative follow-up between both groups. The total esodeviated angle without hyperopic correction of the glasses-discontinued group was significantly lower than that of glasses-maintained group (37.4PD:46.7PD, p < 0.05); there were no significant differences in the remaining esotropic angle after hyperopic correction. The average hyperopic degree in the glasses-discontinued group was significantly lower than that in the glasses-maintained group (+3.0D:+4.7D, p < 0.05), there were no significant differences in the weaning time of hyperopic glasses between both groups. CONCLUSIONS: The esodeviated angle without hyperopic correction was smaller and hyperopic degree was lower in the glasses-discontinued group than in the glasses-maintained group after surgery for partially accommodative esotropia. Therefore, it might be helpful to predict the postoperative possibility to discontinue glasses in the patients with partially accommodative esotropia.

Changes in Hypermetropic Spectacle Correction after Surgery in Partially Accommodative Esotropia

PURPOSE: To investigate the characteristics of successfully weaning patients off of glasses and the change in hypermetropic spectacle correction required for maintaining orthotropia using an analysis of surgery results of patients with partially accommodative esotropia. METHODS: We reviewed the medical records of 104 patients who underwent standard surgery for correcting partially accommodative esotropia. In total, 64 patients who had follow-up periods of at least 2 years were included. The patients were divided into 2 groups: 28 patients who were asked to discontinue their hyperopic glasses (glasses-discontinued group) and 36 patients who still needed hyperopic glasses (glasses-maintained group). We investigated the age at first visit and at surgery, total angle of deviation and residual angle of deviation with correction before surgery, weaning time of hyperopic glasses, follow-up period, and the time at which the hyperopic glasses were discontinued in the glasses-discontinued group. RESULTS: There were no statistically significant differences in the age at first visit and at surgery as well as the duration of postoperative follow-up between both groups. The total esodeviated angle without hyperopic correction of the glasses-discontinued group was significantly lower than that of glasses-maintained group (37.4PD:46.7PD, p < 0.05); there were no significant differences in the remaining esotropic angle after hyperopic correction. The average hyperopic degree in the glasses-discontinued group was significantly lower than that in the glasses-maintained group (+3.0D:+4.7D, p < 0.05), there were no significant differences in the weaning time of hyperopic glasses between both groups. CONCLUSIONS: The esodeviated angle without hyperopic correction was smaller and hyperopic degree was lower in the glasses-discontinued group than in the glasses-maintained group after surgery for partially accommodative esotropia. Therefore, it might be helpful to predict the postoperative possibility to discontinue glasses in the patients with partially accommodative esotropia.

The Ratio of Accommodative-Convergence to Accommodation in Patients with Nonrefractive Accommodative Esotropia

PURPOSE: To measure the ratio of accommodative-convergence to accommodation (AC/A ratio) in patients with nonrefractive accommodative esotropia in comparison to refractive accommodative esotropia and normal groups. METHODS: A total of 43 subjects were divided into 3 groups: the nonrefractive accommodative esotropia group (group 1), the refractive accommodative esotropia group (group 2) and the normal group (group 3). Age, sex, age of onset, and refractive errors were recorded. The deviation angle was measured near and at distance by using a prism cover test. The AC/A ratio was calculated using a gradient method. RESULTS: Refractive errors were 2.3 +/- 1.7 D (OD) and 2.4 +/- 2.1 D (OS) in group 1, 4.8 +/- 0.9 D (OD) and 4.6 +/- 1.1 D (OS) in group 2, and -0.3 +/- 1.5 D (OD) and -0.5 +/- 1.5 D (OS) in group 3. Group 2 had higher mean refractive errors than groups 1 and 3, while the difference in refractive error between group 1 and group 3 was not statistically significant. The AC/A ratio was 5.5 in group 1, 2.1 in group 2 and 2.2 in group 3; there was no significant difference between groups 2 and 3, while group 1 had a significantly higher AC/A ratio than both of these groups. CONCLUSIONS: AC/A ratio in patients with nonrefractive accommodative esotropia is higher than that of refractive accommodative esotropia or normal children. It could be used for bifocal lens as non-surgical treatment.

The Initial Factors Influencing Successful Final Stereoacuity in Refractive Accommodative Esotropia

PURPOSE: To evaluate the initial factors influencing successful final stereoacuity in patients with refractive accommodative esotropia. METHODS: The charts of 48 refractive accommodative esotropia patients 2 years of age or older andassessed using the Titmus stereoacuity test were retrospectively reviewed. Hyperopic refractive error on post-cycloplegic refraction, age at first glasses, stereoacuity after refractive correction and amblyopia were categorized and evaluated as the factors influencing final stereoacuity. RESULTS: The mean follow-up period was 43.51 +/- 30.02 months. The mean hypermetropia at the initial examination was 4.67 +/- 2.18 diopters (D), the mean age at first glasses was 48.09 +/- 20.22 months and the mean stereoacuity after refractive correction was 1243.75 +/- 1378.24 seconds of arc. The rates of successful stereoacuity at the final visit were 83.3% without amblyopia, 75.0% with mild amblyopia and 42.9% with moderate amblyopia which were statistically significant (p = 0.039). Hyperopic refractive error and age at first glasses were categorized as +1.0 to or =+5.0 D and 2 to or =6 years, respectively, and the rates of successful stereoacuity at the final visit were 83.3%, 66.7%, 61.9% (p = 0.362) and 71.4%, 75.0% and 54.5% (p = 0.334), respectively. CONCLUSIONS: The amblyopia at the initial examination was significantly associated with the outcome of stereoacuity at the final visit in patients with refractive accommodative esotropia.

Comparison of Outcomes According to Surgical Method in Partially Accommodative Esotropia in Patients Over 4 Years of Age

PURPOSE: To compare postoperative outcomes according to surgical method in partially accommodative esotropia in patients over 4 years of age. METHODS: We compared motor and sensory outcomes between conventional and augmented surgery in 66 patients. The postoperative follow-up period was at least 24 months. The formula for the amount of the rectus muscle recession was based on the distant angle deviation after hyperopic correction in the conventional group and the average amounts of the distant angle deviation with and without full correction of hyperopia in the augmented group. In addition, the conventional group was divided into 2 sub-groups to compare surgical outcomes. The A group consisted of patients who underwent surgery with the amount of surgical correction based on distant angle deviation after full hyperopic correction. The B group consisted of patients under the same condition after reduced hyperopic correction to achieve best corrected visual acuity (BCVA). RESULTS: Among the patients who had an ocular alignment less than 10 PD, orthophoria was significantly higher in the conventional group than in the augmented group on the last follow-up. When comparing the 2 conventional sub-groups, the postoperative stereoacuity was better in group B than in group A. Among patients with a postoperative overcorrected alignment of more than 10 PD who underwent augmented surgery, 75% showed decreased postoperative stereoacuity compared to preoperative stereoacuity. CONCLUSIONS: In partially accommodative esotropia in patients over 4 years of age, conventional surgery compared to augmented surgery after reduced hyperopic correction is better in order to achieve BCVA for postoperative stereoacuity as well as ocular alignment.

Comparison of Clinical Features in Refractive Accommodative Esotropia According to the Presence of Anisometropia

PURPOSE: To compare the clinical features according to the presence of anisometropia in refractive accommodative esotropia patients. METHODS: Forty-five refractive accommodative esotropia patients were divided into 2 groups : patients who had anisometropia of more than 1.00D (anisometropia group), and patients who had anisometropia of less than 1.00D (isometropia group). Age at onset, age when glasses were first worn, the initial and final angle of esotropia with or without hyperopic correction, the recovery time to orthophoria after hyperopic correction, the degree of stereoacuity and the frequency of amblyopia, the prevalence of deterioration, and the ratio of accommodative-convergence to accommodation were retrospectively reviewed. RESULTS: There were no statistical differences between the 2 groups in the frequency of amblyopia, the prevalence of deterioration, and the ratio of accommodative-convergence to accommodation at the initial and final visit. The angles of deviation with hyperopic correction at the 1-month follow-up visit in the anisometropia group and the isometropia group were 8.80 +/- 5.63 PD for near, 8.67 +/- 5.42 PD for distance, and 4.54 +/- 6.59 PD for near 5.19 +/- 6.7 PD for distance, respectively; the difference was statistically significant (p = 0.042). The recovery time to orthophoria after hyperopic correction in patients associated with anisometropia was 2.20 +/- 1.01 months, significantly longer than 1.47 +/- 0.86 months in patients associated with isometropia (p = 0.017). CONCLUSIONS: In refractive accommodative esotropia patients associated with anisometropia, the recovery time to orthophoria after hyperopic correction was significantly prolonged but there were no statistical differences in other clinical manifestations.

Clinical Features of Refractive Accommodative Esotropia with Hyperopic Anisometropia

PURPOSE: To investigate the clinical features of refractive accommodative esotropia with hyperopic anisometropia. METHODS: Retrospective chart review was performed for 71 patients with refractive accommodative esotropia and hyperopic anisometropia. Patients were divided into isometropia and anisometropia groups, as well as disappeared anisometropia and maintained anisometropia groups. Clinical features such as amblyopia, stereopsis, decompensation, and cessation of spectacle use were reviewed. RESULTS: Anisometropia was found in 14 patients (19.7%). Amblyopia was detected in 35% of the patients in the isometropia group and 67% of the patients in the anisometropia group on the first visit (p = 0.048), but improved to 14% in the isometropia group and 21% in the anisometropia group on the final visit. Good stereopsis was reported in 28% of the patients in the isometropia group and 21% of the patients in the anisometropia group on the first visit, and improved to 67% in the isometropia group and 79% in the anisometropia group on the final visit. There were no differences of prevalence of decompensation and cessation of spectacle use between the 2 groups. Cases with disappeared anisometropia on the final visit were observed in 42.9% of the patients. Disappearance of anisometropia was not related with amblyopia, stereopsis, decompensation, and cessation of spectacle use. CONCLUSIONS: Although refractive accommodative esotropia accompanied by anisometropia has a greater chance to show amblyopia on the initial visit, good prognosis can be expected when the patients are carefully managed with hyperopic correction and occlusion therapy.

Long-Term Follow-Up of Refractive Accommodative Esotropia: Decompensation and Cessation of Spectacle Use

PURPOSE: To analyze clinical characteristics of refractive accommodative esotropia related with the occurrence of decompensation and cessation of spectacle use. METHODS: The records of 60 patients with refractive accommodative esotropia were reviewed. Patients were divided into a control or decompensation group. Twenty-nine patients in the control group who were followed up for long-term were divided into two groups based on spectacle use. RESULTS: In the decompensation group, the amounts of near and distant esodeviation without correction at the first visit and the frequency of failure to achieve central fusion were significantly greater than the control group (p 0.05). In the group that no longer required glasses, the age at the first visit was greater and the amount of hyperopia and the near and distant esodeviations without correction at the first visit were significantly greater than the glasses-wearing group (p 0.05). CONCLUSIONS: In refractive accommodative esotropia, a larger amount of esodeviation at the first visit and failure to achieve central fusion are risk factors for developing decompensation. The older age at diagnosis and smaller amounts of hyperopia and esodeviation at the first visit are predictive factors for the cessation of spectacle use.

Use of atropine to predict the accommodative component in esotropia with hypermetropia.

This cohort study included children with esotropia and hypermetropia of ≥ +2.0 diopters (D). The deviation was measured at presentation, under atropine cycloplegia and 3 months after full refractive correction. Of 44 children with a mean age of 5.2 ± 2.4 years, 25 were males. Eighteen (41%) had fully refractive accommodative esotropia (RAE), 10 (23%) had partial accommodative esotropia (PAE), and 5 (11%) had nonaccommodative esotropia (NAE). Eleven (25%) had convergence excess (CE). Under cycloplegia, all with RAE and RAE with CE had orthotropia. There was no significant change in the deviation in the patients with NAE. The deviation under cycloplegia and that with full refractive correction in PAE and PAE with CE (with +3.0 D addition) were not different. The intraclass correlation coefficient for deviation under cycloplegia and after full refractive correction (+3.0 D addition for CE) was 0.89. It was concluded that ocular deviation under cycloplegia can help to predict the accommodative component in esotropia with hypermetropia.

Predictive Factors of Successful Weaning From Glasses in Accommodative Esotropia Patients

PURPOSE: To investigate the predictive factors of successfully weaning children from glasses with accommodative esotropia who were monitored with manifest refraction on follow-up visits. METHODS: A retrospective review of 48 patients with accommodative esotropia was performed. Weaning was accomplished by monitoring patients with manifest refraction on follow-up visits. The patients were divided into 2 groups: patients who were weaned successfully from glasses and patients who still needed glasses at their final visit. A comparative analysis of the multiple clinical features between the 2 groups was performed. RESULTS: Among the 48 patients, 15 patients were weaned successfully from glasses. The age of onset was significantly different between the 2 groups, 39.6 +/- 14.9 months in patients who were weaned successfully from glasses and 30.7 +/- 16.9 months in patients who still needed glasses. In particular, the patients with onset of accommodative esotropia after 3 years of age were more likely to be weaned from glasses at their final visit. CONCLUSIONS: Monitoring with manifest refraction could be another method of weaning children from glasses with accommodative esotropia and the age of onset appears to be the useful predictor of successful weaning in children who can finally be weaned from glasses.

Clinical Manifestation of Patients with Accommodative Esotropia for 10 Years

PURPOSE: To analyze the clinical features of patients who successfully discontinued correction with hyperopic glasses for refractive accommodative esotropia during a 10 year follow-up. METHODS: The authors of the present study analyzed 29 patients followed-up for a minimum of 10 years after diagnosis of accommodative esotropia. The patients were divided into 2 groups: patients who successfully discontinued correction with hyperopic glasses (10 patients, Group A), and patients who required constant use of hyperopic glasses (19 patients, Group B). The age at first visit, refractive error, deviated angle without correction, stereopsis, and follow-up duration were compared between the 2 groups. RESULTS: The mean age at first visit for all patients was 3.03 +/- 1.46 years, and the follow-up duration was 11.3 +/- 1.51 years. Patients in Group A discontinued the use of hyperopic glasses after 10.26 +/- 2.08 years. There were no statistical differences in mean age at first visit, deviated angle without correction, stereopsis, follow-up duration, or the amount of change in hyperopia. The initial amount of hyperopia in Group A was 3.81 +/- 1.54 D, significantly lower than the 5.12 +/- 1.37 D in Group B. CONCLUSIONS: After a 10 year follow-up of accommodative esotropia, 34% of the patients discontinued the use of hyperopic glasses, and the hyperopic amount at initial visit was statistically lower than that of patients who required constant use of hyperopic glasses.

The Comparison of Surgical Results Between Non-accommodative and Partially Accommodative Esotropia

PURPOSE: To examine the differences in surgical results between non-accommodative esotropia (NAE) and partially accommodative esotropia (PAE). METHODS: This retrospective study included 47 patients undergoing surgery for pediatric esotropia, defined as esotropia with a decrease in the deviated angle of greater than ten prism diopters (PD) upon administration of hyperopic spectacles. On the other hand, NAE was defined as esotropia with a decrease in the deviated angle of less than 10PD. We compared age at surgery, deviated angle at surgery, frequency of amblyopia, and deviated angle at each postoperative period in two groups. RESULTS: Twenty-nine patients belonged to the PAE group, and 18 patients belonged to the NAE group. The age at surgery in the PAE group was higher than that of the NAE group, and the deviated angle for surgical correction was smaller in the PAE group than in the NAE group. No statistically significant difference in the frequency of amblyopia presentation was found between the two groups. The surgical success rates were much higher in the PAE group at postoperative two years and at the final visit compared to those of the NAE group. CONCLUSIONS: In esotropic children who underwent surgery, the long-term surgical success rate was highest in the cases in which the esotropic angle was decreased by hyperopic correction.

Clinical Outcomes of Refractive Accommodative Esotropia in Korean Adolescent Patients

PURPOSE: To report the clinical course of refractive accommodative esotropia (AE) and to determine whether the strabismus resolves during the adolescent years in Korean patients. METHODS: A total of 32 adolescent patients with AE associated with hyperopia were retrospectively reviewed. Ocular alignments, amblyopia, stereopsis, changes in refractive error with time after glasses prescribed, and clinical characteristics were studied. RESULTS: The mean age and follow-up were 14.9 and 10.1 years, respectively at the final visit. The Initial and final refractive errors were 5.16 and 2.52 diopters (D), respectively. Spectacles were initiated at a mean age of 4.7 years, and intentional undercorrection initiated from a mean age of 6.3 years. Hyperopic reduction after prescribing glasses followed the formula: Diopter (D) = 5.23 - 0.02 (Time) - 0.03 (Time)**2. Initially, 16 out of 32 patients (50%) showed fully corrected hyperopia, and eventually, 71.9% wore partially corrected spectacles. The mean change of hyperopia per year was 0.26 D. Six out of 32 patients (18.8%) were successfully discontinued from hyperopic spectacles and the mean age of weaning was 14.7 years. Intentional initial undercorrection did not affect hyperopic reduction (p = 0.123). CONCLUSIONS: AE persists through adolescence for a majority of Korean patients. These patients need to be carefully monitored during follow-up periods because most do not outgrow their hyperopia and need to using spectacles.

A Ratio of Accommodative-Convergence to Accommodation in Patients With Refractive Accommodative Esotropia

PURPOSE: The goals of the present study were to measure a ratio of accommodative-convergence to accommodation (AC/A ratio) in child patients with refractive accommodative esotropia (RAET) and to compare it to the ratio in normal children. METHODS: Patient age, gender, and refractive errors were examined. The deviation angles were measured at near and distance using a prism cover test and were followed by the measurement of the interpupillary distance. The AC/A ratio was calculated using a heterophoria and a gradient method. RESULTS: The present study consisted of 59 patients, 38 patients with RAET and 21 normal children. The mean ages were 9.6 years in patients with RAET and 9.0 years in the normal children. The refractive errors in spherical equivalent were shown to be 4.6D in the right eye and 4.5D in the left eye in patients with RAET and -0.4D and -0.5D in the normal children. The mean values of the AC/A ratio using a gradient method were 1.8 in patients with RAET and 2.2 in the normal children(p=0.44). According to the heterophoria method, the AC/A ratio was 6.2 in patients with RAET and was 5.4 in the normal children(p=0.04). CONCLUSIONS: The AC/A ratio of child patients with RAET was higher than that of normal children when using a heterophoria method. However, there was no difference in the AC/A ratio between the normal children and RAET child patients when using gradient method.