Abstract
Purpose :
To investigate the effect of high AC/A ratio esotropia on visual acuity in children with deviation only at near and its relationship with the use of bifocal glasses
Methods :
We reviewed the charts of 78 children (aged 3-8 years old) diagnosed of high AC/A ratio esotropia with deviation only at near with glasses (orthophoria or only esophoria at distance). Visual acuity (HOTV LogMAR or ETDRS), stereoacuity at near, deviation angle at distance (6 m) and near (35 cm), cycloplegic retinoscopy, and anterior and posterior segment routine examination were carried out. Only patients with at least 1 year of followup were eligible. Patching was used for the treatment of amblyopia. We employed multiple regression to control for potential confounders.
Results :
Of 78 children, 61 were eligible. All patients wore single vision glasses until evaluation 2 months after initial visit. Thereafter, 46 wore bifocals, whereas 15 of them wore single vision glasses. Twenty-seven patients were diagnosed with amblyopia at initial visit. Twenty-one remained amblyopic after 2 months of wearing single vision glasses. In this group, 13 children used bifocals after the 2-month visit and 8 of them continued with single vision glasses. Improvement of visual acuity in the amblyopic eye was larger in the bifocal vs single vision group after adjusting for initial deviation, refraction, age, and amblyopia, at 6 months (2.6 vs 2 logMAR lines, p=0.01; 1.4-fold rate) but not at 1 year (2.6 vs 2.3 logMAR lines, p=0.3). Improvement of stereoacuity was not significantly different between the two groups at 6 months (-0.39 logarcsec vs -0.31 logarcsec p=0.2) and 1 year (-0.41 logarcsec vs -0.38 logarcsec, p= 0.5).
Conclusions :
High AC/A ratio esotropia may cause amblyopia in children with deviation only at near. Use of bifocals could help in the treatment of amblyopia at least initially, whereas it does not have influence on binocularity outcome.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.