May 2007
Volume 48, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2007
Accommodative Convergence in Patients With Infantile Esotropia Before and After Surgery
Author Affiliations & Notes
  • J. Felius
    Retina Foundation of the Southwest, Dallas, Texas
    Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
  • C. S. Cheng
    Retina Foundation of the Southwest, Dallas, Texas
  • X. Wang
    Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
  • D. R. Stager, Sr.
    Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
  • E. E. Birch
    Retina Foundation of the Southwest, Dallas, Texas
    Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
  • Footnotes
    Commercial Relationships J. Felius, None; C.S. Cheng, None; X. Wang, None; D.R. Stager, None; E.E. Birch, None.
  • Footnotes
    Support Fight for Sight Grant-in-Aid 05024, NIH Grant EY05236
Investigative Ophthalmology & Visual Science May 2007, Vol.48, 4867. doi:
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    • Get Citation

      J. Felius, C. S. Cheng, X. Wang, D. R. Stager, Sr., E. E. Birch; Accommodative Convergence in Patients With Infantile Esotropia Before and After Surgery. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4867.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose:: The high incidence of accommodative esotropia in children with a history of successfully treated infantile esotropia remains poorly understood. Here we investigate whether abnormalities in the convergence-accommodation crosslink exist before treatment for infantile esotropia and whether changes occur as a result of surgical alignment of the visual axes.

Methods:: An infrared eccentric photoscreener was used to measure gaze position and refractive status while the infant viewed accommodative targets at distances of 1.0 to 0.25 meter. The response AC/A ratio was measured under free-viewing conditions (closed-loop) and under monocular viewing conditions (open-loop: eliminating the convergence-driven component of accommodation). Data are presented from 15 non-amblyopic patients with infantile esotropia (age 5-12 months) tested before (n=10) and/or after (n=12) surgery. For comparison, 12 normal infants were tested.

Results:: Normal infants showed a mean response AC/A ratio of 0.7 ma/D (closed loop; 95%-c.i., 0.33-1.4) and 0.4 ma/D (open loop; 95%-c.i., 0.0-0.98). Under closed-loop conditions, as many as 50% of patients showed abnormally high AC/A ratio before surgery, vs. 8% after surgery (P=0.043). Eight patients who were tested before and after surgery showed a mean decrease in AC/A ratio from 1.9 ma/D to 0.7 ma/D after surgery (P=0.014). However, none of the patients showed abnormal open-loop AC/A ratios before surgery, while 1 of 7 patients showed abnormally high AC/A after surgery.

Conclusions:: Some patients may habitually under-accommodate in order to reduce over-convergence under free-viewing conditions, resulting in a high closed-loop AC/A. However, no abnormalities in strength of the physiological crosslink (open-loop AC/A) were found before surgery. After surgery, only one patient showed an abnormally high open-loop AC/A. Longitudinal data are being collected to monitor which patients ultimately develop accommodative esotropia by age 4 years.

Keywords: vergence • esotropia and exotropia 
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