Purpose
There is debate regarding the degree of change in refractive error over time in children with accommodative esotropia. We conducted a retrospective cohort study to determine whether there is a measurable change in hypermetropia in children with accommodative esotropia as they age.
Methods
We identified children with accommodative or partially accommodative esotropia diagnosed prior to age 7 years, followed to age 10 or older, and with at least two full cycloplegic refractions, one performed prior to age 7 years and one after age 10 years. Subjects who lacked refractive or orthoptic data, or had a concurrent ocular, motility, or systemic abnormality were excluded. The primary outcome was annual change in spherical equivalent refractive error calculated from linear mixed effect models with assessment for breakpoints based upon the annual changes. The annual change was further calculated during two periods (ages 3 to 7 years and ages 7 to 15 years) with subgroup analysis by baseline refractive error less than or greater than 4 diopters (D) of hypermetropia.
Results
405 subjects met inclusion criteria. Mean age at first and last visit was 3.2 (SD 1.6) and 12.1 (SD 1.9) years, respectively, with the mean number of cycloplegic refractions being 7.6 (SD 2.5). Between ages 3 and 7, refractive error among children with baseline hypermetropia <4 D (n=176) increased by 0.14 D/year (95% CI +0.10 to +0.18), while refractive error was stable among children with baseline 4D or greater (n=229) whose annual change was 0.0 D/year (95% CI -0.03 to +0.04); the difference among groups was significant (p<0.001). Hypermetropia decreased from age 7 to 15 years in both subgroups: <4D subgroup -0.18 D/year (-0.21 to -0.16), 4D+ subgroup -0.20 D/year (-0.22 to -0.17)(comparison between subgroups p=0.527). There were no significant differences in refractive change between fully (n=274) and partially (n=131) accommodative esotropia (p>0.10).
Conclusions
Hypermetropia in children with accommodative esotropia is stable or increases up to age 7 years. Hypermetropia then decreases gradually between ages 7 and 15 years. However, the decrease in refractive error is not large for the great majority of children and is similar regardless of baseline refractive error.