Abstract
Purpose :
To investigate the clinical factors associated with anatomic decompensation in initially well-aligned children diagnosed with accommodative esotropia (ET).
Methods :
This was a retrospective study undertaken at a single academic setting. Pediatric patients younger than five years of age who were diagnosed with accommodative ET and were initially well-aligned with hyperopic correction were included. Patients were evaluated for anatomic decompensation during the first two years of follow up. Decompensation of ET was defined as (1) indication for surgical correction by the physician and/or (2) strabismus of ≥ 8 PD of ET with glasses wear. Clinical factors evaluated as potential risk factors for decompensation included age at diagnosis, age when glasses were prescribed, duration of accommodative ET prior to first clinical visit, initial magnitude of ET, presence of high (≥4.50 D) hyperopic error, and presence of amblyopia. Statistical comparisons were conducted using Chi-square testing for categorical variables and Wilcoxon rank sum testing for continuous variables.
Results :
69 patients (37F/32M) with a mean age 3.4±1.3 years (y) at diagnosis of ET were included in the study. Of the study cohort, 9/69 (13.0%) decompensated at 1 year of follow-up (1Y-FU) while 11/53 (19.6%) decompensated at 2 years of follow-up (2Y-FU).
At 2Y-FU, decompensation was observed in 18.2% of patients with high hyperopia and 21.7% of patients without high hyperopia (p=0.745). At 2Y-FU, decompensation was noted in 19.4% of patients with amblyopia versus 20.0% of those without amblyopia (p=0.952).
The mean age at initial diagnosis of accommodative ET was significantly different in those who decompensated at 2Y-FU compared to those who remained aligned (2.6±1.2 y vs. 3.5±1.2 y; p=0.026). Similarly, patients who decompensated at 2Y-FU were younger when they received their prescription for glasses versus those who remained aligned (2.4±1.3 y vs. 3.4±1.2 y; p=0.014). The duration of ET was similar in the two groups at 2Y-FU (1.1±0.9 y vs. 0.7±0.5 y; p=0.441).
Conclusions :
Earlier age at diagnosis and glasses prescription appear to be associated with a higher risk of decompensation of ET in pediatric patients diagnosed with accommodative ET who were initially well aligned with their hyperopic correction. Earlier onset of misalignment may confer an increased risk for alignment instability in accommodative ET.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.