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.

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.

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.

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.

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.

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.

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.

The Assessment of Stereoacuity in Patients with Strabismus

PURPOSE: To analyze stereoacuity in patients with strabismus using various stereotests. METHODS: Stereoacuity was assessed in children who were diagnosed with intermittent exotropia or refractive accommodative esotropia using the Titmus stereotest, TNO stereotest, and the Lang II stereotest. Patients with amblyopia or previous ocular surgery were excluded. RESULTS: Ninety-four patients with intermittent exotropia and 36 patients with refractive accommodative esotropia were included; the mean age was 7.2 years. The mean stereoacuity in intermittent exotropia was 143.1+/-207.9 seconds of arc with the Titmus stereotest, 130.2+/-103.7 seconds of arc with the TNO stereotest, and 200.0+/-0.0 seconds of arc with the Lang II stereotest. The mean stereoacuity in refractive accommodative esotropia was 430.3+/-288.6 seconds of arc, 232.5+/-90.0 seconds of arc, and 230.0+/-97.9 seconds of arc, respectively. The absence of stereoacuity was more frequent in patients with refractive accommodative esotropia than in patients with intermittent exotropia, and both groups of patients showed the largest proportion of absent stereopsis with the TNO stereotest. No factor was significant for stereopsis in patients with intermittent exotropia and patients with refractive accommodative esotropia. CONCLUSIONS: Stereoacuity showed various seconds of arc according to the type of stereotest in the same patient. Patients with refractive accommodative esotropia showed lower stereoacuity in all stereotests than patients with intermittent exotropia. TNO stereotests are sensitive enough to detect the absence of stereopsis in patients with strabismus.

Five-Year Follow-up Results of Refractive Accommodative Esotropia

PURPOSE: To evaluate the clinical characteristics of refractive accommodative esotropia followed up for 5 years. METHODS: Forty-three subjects with refractive accommodative esotropia, who had been followed up for at least 5 years were included in this study. Age and sex distribution, age at onset and the interval between onset of esotropia and initial visit were evaluated. Changes of the angle of deviation and the amount of hyperopia during follow-up period were analyzed. RESULTS: The initial amount of hyperopia of 4.42+/-3.27D was decreased to 3.84+/-3.46D by the last exam. The average rate of hyperopia decrease per year was 0.12 diopters. The average angles of deviation at the initial and final exam were 31.74+/-13.72PD and 30.11+/-14.27PD, respectively. Among the 43 subjects who participated in this study, decompensation occurred in 2 patients in the third year and 1 patient in the fourth year. CONCLUSIONS: There is a tendency for the amount of hyperopia to decrease over time. Further, deviation may deteriorate over time as well. Thus, long term follow-up management is necessary to control deviation in patients with refractive accommodative esotropia.

Change of Refractive Error in Patients with Refractive Accommodative Esotropia

PURPOSE: To evaluate the degree and change in refractive error and the relation of refractive error, the angle of deviation and amblyopia in patient with refractive accommodative esotropia. METHODS: Children with refractive accommodative esotropia were retrospectively included in the study. The factor studied were sex, age at the first visit, ocular alignment, refractive error and amblyopia. RESULTS: The average age at the first visit was 4.01+/-1.86 years. And, the average angle of esodeviation was 22.23+/-13.74PD for the near and 21.51+/-12.01PD for the distant. The average manifest and cycloplegic refraction measured at patient's first visit were +2.35+/-2.87D and +4.87+/-1.77D respectively. The difference between cycloplegic and manifest refraction decreased gradually. After 3 years, the average manifest and cycloplegic refraction were +3.42+/-1.80PD and +4.33+/-1.77D. The refractive error didn't significantly affect the degree of esodeviation (r=0.051). Twenty-three of patients were amblyopia. The refraction of amblyopic and non amblyopic patient was +5.07+/-1.85D and +4.50+/-2.47D, respectively. However, this difference was not statistically significant. CONCLUSIONS: Mean cycloplegic refraction decreased significantly over a 3-year period. After full correction with glasses, the difference between cycloplegic and manifest refraction decreased. The refractive error was not associated with the degree of deviation anlge, amblyopia occurrence and treatment success.

Occurrence and Risk Factors of Decompensation and Additional Treatment in Refractive Accommodative Esotropia

PURPOSE: To examine the occurrence and risk factors of decompensation and the additional treatment of increased hyperopia in refractive accommodative esotropia. METHODS: Seventy children with refractive accommodative esotropia were followed up for at least 2 years. Time of decompensation and additional treatment, initial refractive error, initial deviation, and controlled deviation were all studied. RESULTS: Decompensation and additional treatment occurred on average at 21.8 months and 22.2 months in eight patients, respectively, and constant survival was achieved after 4 years of full correction of the refractive error, as shown on a Kaplan-Meier survival curve. In the decompensation, additional treatment and control groups, initial refractive errors were 3.97+/-1.07D, 4.06+/-1.92D and 4.60+/-1.29D, respectively; initial deviations were 36.25+/-12.75PD, 31.25+/-10.61PD and 26.02+/-8.62PD, respectively; and controlled deviations were 4.50+/-6.30PD, 4.50+/-4.63PD and 2.65+/-4.10PD, respectively. There was a significant difference in initial deviation between the decompensation and control groups (p=0.011). CONCLUSIONS: The treatment of decompensation and increased hyperopia warranted careful follow-up in the first 4 years after treatment, and patients with large initial deviation risked decompensation.

Clinical Features of Refractive Accommodative Esotropia according to the Age of Onset

PURPOSE: To examine the difference of clinical features according to age of onset of refractive accommodative esotropia. METHODS: We retrospectively analyzed the medical record of 52 cases of refractive accommodative esotropia for more than 12 months of follow-up from March, 2000 to December, 2003. The factors we compared were gender, age of first ocular examination, interval from age of onset to first glasses, preoperative refractive error, amount of deviation corrected with hyperopic glasses, stereopsis and associated ocular conditions. RESULTS: Cases were grouped according to age of onset. Fourteen (27%) patients were less than 2 years old., 32 (62%) were between 2 to 4 years old, and 6 (11%) were between 4 to 6 years old 6. the group less than 2 years old showed lower levels of preoperative refractive error than the group more than 2 years old. The younger the age of onset, the lager the deviation angle without hyperopic glasses. There were no differences according to age of onset in gender, interval from age of onset to first glasses, stereopsis, anisometropia or amblyopia. CONCLUSIONS: In refractive accommodative esotropia, the younger the age of onset is, the lager the deviation angle without hyperopic glasses and the greater the deviation can be corrected with hyperopic glasses.

Refractive Accommodative Esotropia Associated with Mild Hyperopia

PURPOSE: To evaluate the clinical features, courses, and prognosis of refractive accommodative esotropia associated with mild hyperopia. METHODS: We reviewed the records of 14 patients who were diagnosed with refractive accommodative esotropia associated with hyperopia of +2.00 diopters (D) or less. Age at onset and wearing glasses, refractive errors, angle of deviation before and after wearing glasses, binocular sensory status and the presence of amblyopia were evaluated for each patient. RESULTS: The average onset of esotropia was 25.2+/-22.0 months of age, and the average first use of glasses occurred at 65.9+/-12.9 months. The average angle of deviation at distance and near without correction were 21.7+/-8.7 prism diopters (PD) and 24.6+/-6.4PD, respectively. The average refractive error was +1.28+/-0.52D in the right eye and +1.41+/-0.55D in the left eye. The average angles of deviation at distance and near with correction were 3.0+/-2.7PD and 6.0+/-3.0PD, respectively. Among 14 patients, 9 showed esophoria or esotropia of 10PD or less within 14 weeks after wearing glasses. Decompensation developed in 1 patient who underwent recession of medial rectus. CONCLUSIONS: Hyperopia of +2.00D or less can cause refractive accommodative esotropia, so we should recommend the correction of hyperopia of +2.00D or less with esotropia.

Clinical Features of Refractive Accommodative Esotropia and Partially Accommodative Esotropia

PURPOSE: To examine the difference between refractive accommodative esotropia and partially accommodative esotropia retrospectively. METHODS: Children with refractive accommodative esotropia and partially accommodative esotropia respectively were included in the study. The features studied were sex, age at the time of presentation, ocular alignment, refractive error, and amblyopia. RESULTS: Seventy-two children with refractive accommodative esotropia and 60 children with partially accommodative esotropia were identified. The age of each group was 40.51 +/- 9.63 months and 30.15 +/- 16.95 months respectively at the time of presentation. Amounts of esodeviation were 29.40 +/- 12.13PD and 44.57 +/- 15.92 PD. Refractive error were +4.59 +/- 1.43D and +3.63 +/- 1.61D at the time of presentation. Incidence of amblyopia were 31% and 40% at the time of presentation. Refractive error at the final visit were +3.79 +/- 1.37D and +3.18 +/- 1.48D. Incidence of amblyopia at the final visit were 11% and 23%. CONCLUSIONS: Patients of partially accommodative esotropia showed statistically significantly different features: early onset, large amount of esodeviation, and small refractive errors. Higher incidence of amblyopia was noted at partially accommodative esotropia, but this result was not statistically significant.

The Effect of Atropinization of Refractive Accommodative Esotropia Patients with Amblyopia

PURPOSE: The present study examined the effect of amblyopia treatment by applying atropine to patients with refractive accommodative esotropia and amblyopia. METHODS: The subjects were chosen from patients who visited the Wonju Christian Hospital for esotropia between July 2000 and July 2002. The subjects of this study included 15 patients who had refractive accommodative esotropia and amblyopia, 7 patients who could not receive visual acuity tests and showed monocular fixation. Atropine was applied to the 22 subjects, and its effect in treating amblyopia was examined. RESULTS: The fixation changed from monocular esotropia to alternating strabismus, or from healthy eye to amblyopia in 20 subjects (90.9%). Alternating strabismus continued since the dropping of atropine was stopped after the treatment of 17 subjects (77.3%), and fixating eyes changed to sound eyes in 5 subjects (22.7%). For patients who could receive visual acuity tests, 2 patients (13.4%) showed that those visual acuity did not improve by one line on the Snellen chart, and 13 patients (86.7%) showed improvement by two or more lines. CONCLUSIONS: In the present study, the effect of atropine applied to patients with refractive accommodative esotropia and amblyopia was not perfect in treating the amblyopia. However, 86.6% of them who could receive visual acuity tests showed improvement by two or more lines on the Snellen Chart, and 40.0% of them showed same visual acuity with sound eyes. In addition, in 77.3% of the subjects, the type of esotropia changed from monocular esotropia to alternating strabismus.

Clinical Studies on Accormmodative Esotropia

Esotropia that is related to accommodative effort may be divided into two major categories: (1) refractive accommodative esotropia with a normal AC/A ratio and (2) nonrefractive accommodative esotropia with a high AC/A ratio. To evaluatedthe clinical characteristics and the results of therapy, we performed a clinical analysis of 54 cases of accommodative esotropia. Female were 28 cases and male 26. The age of onset were 0 to 6 years with most of the cases were 0 to 2 years. The refractive errors were ranged from less than +2.00D to over +6.00D. The amount of deviation before correction with glasses were 20-29delta in 16 cases, 30-39delta in 25, 40-49delta in 12 and one cases was over 50 delta. The refractive type was 46 cases and 8 cases were nonrefractive type. It is recommended that the patients with accommodative esotropia should be followed up for a long time even with their glasses, because of variable clinical course.

Dissociated Horizontal Deviation in the Refractive Accommodative Esotropia with Amblyopia

Dissociated horizontal deviation(DHD) is a rare type of dissociative strabismus. It dose not obey the Hering`s law of equal innervation and is expressed in associated with dissociated vertical deviation or asymmetrical nystagmus blockage syndrome. We observed 6 cases of DHD among the patients with refractive accommodative esotropia associated with amblyopia. The mean age of the patients was 3.6 years and the average refractive error was +5.35D in the dominant eyes and +6.29D in the amblyopic eyes. The average visual acuity was 0.38 with the dominant eyes and 0.17 with the amblyopic eyes. The average angle of deviation was 40.0delta with fixation in the dominant eyes and 24.3delta in the amblyopic eyes. The authors speculate that this difference of angle deviation was caused by the weaker accommodative convergence at the time of fixation by the amblyopic eye that appeared to have decreased accommodative amplitudes.