Accommodative esotropia who needs spectacles for good ocular alignment after refractive shift below +2.00 diopters

Characteristics of Patients with Accommodative Esotropia Who Need Glasses for Stable Alignment after Myopic Shift

Purpose: We analyzed the characteristics of patients with refractive accommodative esotropia (RAET) who required glasses for stable alignment after a myopic shift.Methods: We retrospectively analyzed the medical records of patients diagnosed with RAET at the initial visit, and who had developed a myopic shift in both eyes over the 5-year follow-up period. To evaluate clinical factors associated with the persistence of esotropia after myopia, the enrolled patients were divided into two groups; patients with RAET who needed glasses for stable alignment after a myopic shift (unstable group) and patients with RAET whose esotropia resolved after a myopic shift (stable group).Results: A total of 55 patients met the inclusion criteria. The mean follow-up period was 13.8 ± 5.7 years (5-27 years). Spherical equivalent (SE) refractive errors at the initial visit were +3.1 ± 1.6 diopters (D) (+1.00 to +7.25 D) and -1.5 ± 0.9 D (-4.38 to -0.5 D) at the last visit. Of the 55 RAET patients, 24 were included in the unstable group and 31 were included in the stable group. No significant differences in gender, age at diagnosis, SE refractive error, or angle of esotropia with glasses were observed between the two groups. However, significantly more patients failed the Lang I test or had anisometropia over 1.5 D at the last visit, and the duration between the onset of esotropia and prescribing glasses was significantly longer in the unstable group than in the stable group.Conclusions: Glasses may be needed for stable alignment even after a myopic shift in RAET patients with long durations of misalignment, poor stereopsis, and anisometropia.

Changes in Esodeviation after Inferior Oblique Recession in Patients with Refractive Accommodative Esotropia and Inferior Oblique Overaction

PURPOSE

To evaluate the changes in esodeviation after inferior oblique (IO) recession in patients with refractive accommodative esotropia and IO overaction.

METHODS

Graded IO recession was performed in 68 patients who were diagnosed with refractive accommodative esotropia with IO overaction. The patients were followed for at least 3 months after surgery and the angle of esodeviation with correction was evaluated at distance and near at each follow-up evaluation. The patients were divided into two groups: patients who underwent unilateral IO recession (UIO-Rec) and patients who underwent bilateral IO recession (BIO-Rec). The change in esodeviation after surgery was compared between the two groups.

RESULTS

A total of 68 patients were enrolled in this study, with 38 patients in the UIO-Rec group and 30 in the BIO-Rec group. In the UIO-Rec group, there was no statistically significant difference in esodeviation before and after surgery. In the BIO-Rec group, esodeviation at distance increased significantly 1 day postoperatively (p = 0.033). However, esodeviation returned to the preoperative value one week after surgery (p = 0.665). Changes in esodeviation at distance were significantly greater in the BIO-Rec group than in the UIO-Rec group one day after surgery (p = 0.044).

CONCLUSIONS

Bilateral IO-weakening surgery induced a transient increase in esodeviation in patients with refractive accommodative esotropia. However, we found no evidence that well-controlled esotropia with corrected hyperopia became decompensated after IO-weakening surgery, as induced esodeviation was minor and temporary.

The effects of partial and full correction of refractive errors on sensorial and motor outcomes in children with refractive accommodative esotropia

PURPOSE

To investigate the effects of partial and full correction of refractive errors on sensorial and motor outcomes in children with refractive accommodative esotropia (RAE).

METHODS

The records of pediatric cases with full RAE were reviewed; their first and last sensorial and motor findings were evaluated in two groups, classified as partial (Group 1) and full correction (Group 2) of refractive errors.

RESULTS

The mean age at first admission was 5.84 ± 3.62 years in Group 1 (n = 35) and 6.35 ± 3.26 years in Group 2 (n = 46) (p = 0.335). Mean change in best corrected visual acuity (BCVA) was 0.24 ± 0.17 logarithm of the minimum angle of resolution (logMAR) in Group 1 and 0.13 ± 0.16 logMAR in Group 2 (p = 0.001). Duration of deviation, baseline refraction and amount of reduced refraction showed significant effects on change in BCVA (p < 0.05). Significant correlation was determined between binocular vision (BOV), duration of deviation and uncorrected baseline amount of deviation (p < 0.05). The baseline BOV rates were significantly high in fully corrected Group 2, and also were found to have increased in Group 1 (p < 0.05). Change in refraction was - 0.09 ± 1.08 and + 0.35 ± 0.76 diopters in Groups 1 and 2, respectively (p = 0.005). Duration of deviation, baseline refraction and the amount of reduced refraction had significant effects on change in refraction (p < 0.05). Change in deviation without refractive correction was - 0.74 ± 7.22 prism diopters in Group 1 and - 3.24 ± 10.41 prism diopters in Group 2 (p = 0.472). Duration of follow-up and uncorrected baseline deviation showed significant effects on change in deviation (p < 0.05).

CONCLUSIONS

Although the BOV rates and BCVA were initially high in fully corrected patients, they finally improved significantly in both the fully and partially corrected patients. Full hypermetropic correction may also cause an increase in the refractive error with a possible negative effect on emmetropization. The negative effect of the duration of deviation on BOV and BCVA demonstrates the significance of early treatment in RAE cases.

Prognostic factors for stereopsis in refractive accommodative esotropia

OBJECTIVE

To determine the prognostic factors affecting stereoacuity in patients with refractive accommodative esotropia (RAE) according to the results of long follow- up period.

METHODS

We reviewed the charts of 70 patients with RAE between the years 1985-2014. Patients were classified into three groups. G-1: Stereoacuity score 40 second/arc. G-2: Stereoacuity score >40 second/arc (50-3000). G-3: No binocular vision. Initiation age of RAE, duration of deviation, refractive error, amblyopia, amblyopia treatment, anisometropia, visual acuity, family history, angle of deviation for distance and near at each group and the prognostic factors affecting stereoacuity were analyzed.

RESULTS

The mean initiation age of RAE was 2.7±1.5 years, the mean age at first visit was 6.4±4.2 years. The mean follow up time was 7.3±4.4 years. Seven patients had 40 second/arc, 48 patients had 50 to 3000 second/arc stereoacuity, 15 patients had no binocular vision. Mean deviation for near was statistically higher in group 2 and 3. Visual acuity levels were higher in group 1 and 2 and was statistically significant. Low visual acuity (p=0.001, 0.008), higher angle of deviation at near (p=0.01), increased duration of deviation (p=0.01), presence of amblyopia (p=0.001) and irregularity of amblyopia treatment (p=0.01) were significantly related with poor stereoacuity.

CONCLUSION

According to the prognostic factors low stereoacuity was mostly related with amblyopia as a result the late presentation of the patients in seeking care. Appropriate treatment as full refractive correction and amblyopia treatment during the RAE is important for development of good stereopsis. Also angle of deviation at near and duration of deviation can be a useful predictor for poor stereoacuity levels.