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Jingyun Wang, Eileen E. Birch, Christina Cheng, Kathryn M. Haider, Dana L. Donaldson, Heather A. Smith, Gavin J. Roberts, Derek T. Sprunger, Daniel E. Neely, David A. Plager; Longitudinal Interocular Difference of Refractive Error in Children with Accommodative Esotropia. Invest. Ophthalmol. Vis. Sci. 2012;53(14):146.
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Anisometropia is associated with increased risk for accommodative esotropia (ET) in hyperopic children (Weakley & Birch, 2000). The aim of this study was to evaluate longitudinal changes in anisometropia and its association with visual deficits in children with accommodative ET.
Retrospective cohort study of children with accommodative ET. Eligibility criteria included: initial visit after 1 year and before 4 years of age and final visit after 7 years of age; with full cycloplegic refraction correction on first follow-up examination. Cycloplegic refractions culled from medical records were converted into power vector components: M (spherical equivalent), J0 (positive J0 indicates with-the-rule astigmatism) and J45 (oblique astigmatism) in diopters (D). Unilateral amblyopia was defined interocular visual acuity difference ≥0.2 logMAR (2 lines); bilateral amblyopia was defined as visual acuity worse than 0.30 logMAR (20/40) in both eyes.
The study included 87 patients. Before 7 years of age, mean M did not change significantly, and ranged from 4.5 to 5.7D. At all ages, mean J0 ranged from 0.1 to 0.5D, while mean J45 was within ±0.1D. The prevalence of anisometropia (M≥1D) was 26% at the initial visit and 32% at the final visit; only 60% had no anisometropia at both the initial and last visit. Among the 23 children who had anisometropia on the initial visit, 70% (16/23) had persistent anisometropia ≥1D throughout ≥3 years follow-up; 30% had anisometropia that diminished to <1.00 D by the final visit. In addition, 12 children who did not have anisometropia on the initial visit developed anisometropia during follow up. Interocular difference in M at the final visit was highly correlated with that at the initial visit (r= 0.78, p<0.001); that is, children who had large amounts of anisometropia tended to have persistent anisometropia. At the final visit, 3% (3/87) had bilateral amblyopia, 29% (25/87) had unilateral amblyopia, and 65% (56/87) were non-amblyopic. Risk for amblyopia was associated with anisometropia at the initial visit (OR=3.46; CI95=[1.71,6.99]; p<0.001) and at the final visit (OR=2.56; CI95=[1.42, 4.61]; p=0.002).
The prevalence of anisometropia among children with accommodative ET was approximately a factor of 10 higher than the prevalence in population-based studies (1.6-4.3%). In children with accommodative ET, anisometropia develops dynamically. Anisometropia at the initial visit is highly associated with later anisometropia and elevated risk for amblyopia.
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