The Long-term Follow-up of Accommodative Esotropia in a Population-based Cohort of Children

Abstract

Purpose To report refractive and surgical outcomes in a cohort of children with accommodative esotropia. Design Retrospective population-based cohort. Participants All pediatric patients (<19 years) diagnosed with accommodative esotropia in Olmsted County, Minnesota from January 1, 1975, through December 31, 1994. Methods Medical records identified by the Rochester Epidemiology Project were reviewed for spectacle and surgical management. Main Outcome Measures Rate of surgical intervention and discontinuation of spectacles for esotropia. Results A total of 306 children with accommodative esotropia were diagnosed during the study years; 244 (80%) were fully accommodative (FAET) and 62 (20%) were partially accommodative (PAET). The Kaplan-Meier rate of discontinuing spectacles for strabismus in this population was 8% by 5 years after diagnosis, 20% by 10 years, and 37% by 20 years. Children born prematurely (p=0.046) or having a greater initial hyperopic refractive error (p<0.001) were significantly less likely to become spectacle-free during the follow-up period. During a median follow-up of 9.8 years (range, 0 to 27.9 years), 33 (13.5%) of the 244 with FAET eventually underwent strabismus surgery. Boys (p=0.039) and an earlier age at onset (p=0.008) and diagnosis (p<0.001) of FAET were associated with a higher likelihood of requiring surgery. Conclusions The majority of children with accommodative esotropia in this population continued to require spectacle correction into their second decade of life. A small proportion of children with FAET required surgical intervention, which was more likely to occur among males and in those with an earlier age at onset and diagnosis of their deviation.

Characteristics of Esodeviation Related to Hyperopia in Children Aged 4 to 6 Years: A Retrospective Cohort Study

“…However, definitive conclusions cannot be drawn because compliance was not directly assessed. Refractive errors under cycloplegic refraction were found to be lower in the PAET group, consistent with previous reports [ 5 ]. This observation may reflect a higher accommodative convergence to accommodation (AC/A) ratio in the PAET group, despite lower hyperopia.…”

Characteristics of Esodeviation Related to Hyperopia in Children Aged 4 to 6 Years: A Retrospective Cohort Study

“…However, definitive conclusions cannot be drawn because compliance was not directly assessed. Refractive errors under cycloplegic refraction were found to be lower in the PAET group, consistent with previous reports [ 5 ]. This observation may reflect a higher accommodative convergence to accommodation (AC/A) ratio in the PAET group, despite lower hyperopia.…”

Factors influencing the therapeutic effect of hyperopic correction on esotropia in patients with partially accommodative esotropia

“…9,10 In contrast, children diagnosed with PAET show a hyperopic refractive error that continues to increase until 7 years of age, and then a slight decline from ages 7 to 14, but these individuals remained hyperopic in adulthood and most retain a need to wear spectacles. 7,[11][12][13][14][15] This observation is consistent with the trend observed in the present study where participants over 9 years of age exhibited significantly higher amount hyperopia when compared with those under 9 years of age. In Tables S4 and S5, the results demonstrate that a larger angle of esodeviation at distance was associated with a higher SE.…”

“…In most children, the hyperopic refractive error decreases rapidly 3–9 months after birth, and is followed by a long period of near‐emmetropia between 1 and 5 years of age 9,10 . In contrast, children diagnosed with PAET show a hyperopic refractive error that continues to increase until 7 years of age, and then a slight decline from ages 7 to 14, but these individuals remained hyperopic in adulthood and most retain a need to wear spectacles 7,11–15 . This observation is consistent with the trend observed in the present study where participants over 9 years of age exhibited significantly higher amount hyperopia when compared with those under 9 years of age.…”

Accommodative esotropia

“…Similar to other studies,[ 7 8 ] patients with FAET in the study cohort were found to have higher hypermetropia than those with PAET. A slight increase (mean 0.50D) in hypermetropia was noted over 5 years.…”

“…This is particularly seen in the presence of amblyopia. [ 6 7 16 ] Similar to other studies, we report a good visual outcome in our cohort. Good outcomes appear to be linked to compliance with glasses and amblyopia therapy.…”

Characteristics of Esodeviation Related to Hyperopia in Children Aged 4 to 6 Years: A Retrospective Cohort Study

“…However, definitive conclusions cannot be drawn because compliance was not directly assessed. Refractive errors under cycloplegic refraction were found to be lower in the PAET group, consistent with previous reports [ 5 ]. This observation may reflect a higher accommodative convergence to accommodation (AC/A) ratio in the PAET group, despite lower hyperopia.…”

Factors influencing the therapeutic effect of hyperopic correction on esotropia in patients with partially accommodative esotropia

“…9,10 In contrast, children diagnosed with PAET show a hyperopic refractive error that continues to increase until 7 years of age, and then a slight decline from ages 7 to 14, but these individuals remained hyperopic in adulthood and most retain a need to wear spectacles. 7,[11][12][13][14][15] This observation is consistent with the trend observed in the present study where participants over 9 years of age exhibited significantly higher amount hyperopia when compared with those under 9 years of age. In Tables S4 and S5, the results demonstrate that a larger angle of esodeviation at distance was associated with a higher SE.…”

“…In most children, the hyperopic refractive error decreases rapidly 3–9 months after birth, and is followed by a long period of near‐emmetropia between 1 and 5 years of age 9,10 . In contrast, children diagnosed with PAET show a hyperopic refractive error that continues to increase until 7 years of age, and then a slight decline from ages 7 to 14, but these individuals remained hyperopic in adulthood and most retain a need to wear spectacles 7,11–15 . This observation is consistent with the trend observed in the present study where participants over 9 years of age exhibited significantly higher amount hyperopia when compared with those under 9 years of age.…”

Accommodative esotropia

“…Similar to other studies,[ 7 8 ] patients with FAET in the study cohort were found to have higher hypermetropia than those with PAET. A slight increase (mean 0.50D) in hypermetropia was noted over 5 years.…”

“…This is particularly seen in the presence of amblyopia. [ 6 7 16 ] Similar to other studies, we report a good visual outcome in our cohort. Good outcomes appear to be linked to compliance with glasses and amblyopia therapy.…”

Characteristics of Esodeviation Related to Hyperopia in Children Aged 4 to 6 Years: A Retrospective Cohort Study

“…However, definitive conclusions cannot be drawn because compliance was not directly assessed. Refractive errors under cycloplegic refraction were found to be lower in the PAET group, consistent with previous reports [ 5 ]. This observation may reflect a higher accommodative convergence to accommodation (AC/A) ratio in the PAET group, despite lower hyperopia.…”

Factors influencing the therapeutic effect of hyperopic correction on esotropia in patients with partially accommodative esotropia

“…9,10 In contrast, children diagnosed with PAET show a hyperopic refractive error that continues to increase until 7 years of age, and then a slight decline from ages 7 to 14, but these individuals remained hyperopic in adulthood and most retain a need to wear spectacles. 7,[11][12][13][14][15] This observation is consistent with the trend observed in the present study where participants over 9 years of age exhibited significantly higher amount hyperopia when compared with those under 9 years of age. In Tables S4 and S5, the results demonstrate that a larger angle of esodeviation at distance was associated with a higher SE.…”

“…In most children, the hyperopic refractive error decreases rapidly 3–9 months after birth, and is followed by a long period of near‐emmetropia between 1 and 5 years of age 9,10 . In contrast, children diagnosed with PAET show a hyperopic refractive error that continues to increase until 7 years of age, and then a slight decline from ages 7 to 14, but these individuals remained hyperopic in adulthood and most retain a need to wear spectacles 7,11–15 . This observation is consistent with the trend observed in the present study where participants over 9 years of age exhibited significantly higher amount hyperopia when compared with those under 9 years of age.…”

Accommodative esotropia

“…Similar to other studies,[ 7 8 ] patients with FAET in the study cohort were found to have higher hypermetropia than those with PAET. A slight increase (mean 0.50D) in hypermetropia was noted over 5 years.…”

“…This is particularly seen in the presence of amblyopia. [ 6 7 16 ] Similar to other studies, we report a good visual outcome in our cohort. Good outcomes appear to be linked to compliance with glasses and amblyopia therapy.…”