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SR Lambert, J Sramek, M Lynn; Emmetropization in Children with Accommodative Esotropia . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4681.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To evaluate emmetropization in children with accommodative esotropia following a gradual reduction in their hyeropic refractive correction. Methods:The hyperopic correction was systematically reduced in a cohort of children with fully accommodative esotropia who had been orthotropic for one year or longer wearing their full hyperopic correction. Children were weaned in 0.50 D increments until spectacles were discontinued or they developed esotropia, asthenopia or decreased vision. Patients with amblyopia or who had previously undergone strabismus surgery were excluded. Results:Thirteen of 21 children (62%) were able to discontinue spectacle use. Lower baseline refractive errors (OD, +2.47 vs +3.95 D, OS +2.49 vs +4.02 D) were significantly correlated with the discontinuation of spectacles (p<.001). The children who were able to discontinue spectacle use had a reduction in their hyperopia over the course of the trial (OD, -0.45 D; OS, -0.39 D), whereas the children who remained dependent on spectacles had an increase in their hyperopia (OD, +0.27 D; OS +0.63 D). In addition, the children who remained dependent on spectacles developed more astigmatism (OD, +1.44 vs +0.31, p=.03; OS, +1.34 vs +0.29, p=.01). Conclusion:Children with accommodative esotropia and baseline hyperopic errors of 3 D or less may experience at least partial emmetropization if their hyperopic refractive error is gradually reduced. The same effect was not observed in children with baseline hyperopic refractive errors ≷3 D. These findings suggest that the failure of children with accommodative esotropia and low baseline refractive errors to undergo emmetropization may be a consequence of them wearing their full hyperopic correction rather than an intrinsic defect in emmetropization.
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