Treatment outcome in refractive accommodative esotropia

Abstract

Background Accommodative esotropia (ET) usually presents in preschool years. It is often intermittent, and the deviation is typically eliminated by controlling the accommodative effort with optical correction of hypermetropia. Objective The aim of this study was to document the clinical features and to assess the functional outcome in patients with refractive accommodative esotropia (RAE) in terms of amblyopia and binocular vision and to analyze the possible risk factors involving the development of amblyopia. Patients and methods We retrospectively reviewed the records of 60 patients diagnosed with fully accommodative esotropia (FAET). Multiple parameters were reviewed, including age of onset, age of initiation of treatment, initial and final cycloplegic refraction, distance and near deviation with and without glasses, stereoacuity, presence of anisometropia, and change in hyperopia. Results The mean age of onset and age of initiation of treatment were 2.53±1.42 and 2.73±1.25 years, respectively. The mean spherical equivalent refraction at the initial visit was +5.36±1.48 diopters (D) in the right eyes and +5.62±1.43 D in the left eyes. Anisometropia was present in 33.33% of the patients. Fusion was achieved in 90% of the patients, with 38 (63.33%) patients having stereopsis ranging from 40–100 sec/arc and 22 (36.67%) having stereopsis between 100 and 200 sec/arc with the Titmus fly test. Amblyopia was reduced from 50% to 16.67%. Anisometropia was found to be the only statistically significant risk factor for the development of amblyopia (P<0.001). Hypermetropia showed a tendency either to remain stable or to increase over the first seven years of life and then tended to decrease. Conclusion Most of the patients with FAET have an excellent outcome in terms of visual acuity and binocular vision. Amblyopia is common among patients with RAE and the current management strategies resulted in marked reduction in the prevalence of amblyopia.