Purpose:To identify the characteristics of adult patients who develop acute concomitant esotropia of adulthood.Design: Retrospective noncomparative case series. Participants: Ten patients were included in this study. Intervention:The charts of all adults with acute-onset concomitant esotropia who were examined at our institute between 1990 and 1997 were reviewed, and those who had developed the syndrome when they were older than the age of 16 years were included in this study. All participants underwent a complete ocular and physical examination, including brain and orbital computed tomography.Main Outcome Measures: Angle of esotropia, measured by the prism and cover test. Results:The mean age Ϯ standard deviation at the time of the ocular and physical examination was 38 Ϯ 18.6 years (range, 18 -70 years). The mean myopic error was Ϫ4.1 Ϯ 3.2 diopters (range, ϩ2.0 to Ϫ8.5 diopters). Nine of the 10 patients were myopic. The mean angle of esotropia was 33.8 Ϯ 14.7 prism diopters (range, 18 -60 prism diopters). The mean period of follow-up was 2.2 Ϯ 1.0 years (range, 1-4 years). After surgery, all patients were orthophoric or minimally esophoric, and in all of them, stereoacuity (measured by the Titmus stereofly test) was 40 arc seconds.Conclusions: In a well-defined group of adult patients with acute-onset concomitant esotropia, almost all were myopic, and all regained normal stereopsis after surgery. Acute concomitant esotropia of adulthood should probably be classified as a distinct subgroup of acute-onset esotropia.

Recent studies have shown that perceptual learning has the potential to treat amblyopia. In this study we tested whether a recent perceptual learning technique that improved visual functions in adults can be applied to improve the vision of children after the conventional treatment of patching has failed. A prospective clinical pilot study was carried out in children who were non-compliant with patching or in whom patching had failed despite good compliance. Each child underwent a complete eye examination before and after treatment. The treatment was based on a perceptual learning technique that was similar to the adult study [Polat, U., Ma-Naim, T., Belkin, M., & Sagi, D. (2004). Improving vision in adult amblyopia by perceptual learning. Proceedings of the National Academy of Sciences of the United States of America, 101(17), 6692-6697]. Between blocks, children played a computer game to engage and maintain their attention in order to increase compliance. Each child received two treatment sessions a week, with a total of not more than 40 sessions. Each session lasted for about 1h and included a total practice time of about 30min. The age of the children (n=5) was between 7 and 8years (mean 7.3years). For the whole group, the average improvement in visual acuity was 1.5 Snellen lines or 2.12 ETDRS lines. The training improved the contrast sensitivity, which reached the normal range after treatment. Thus, the perceptual learning technique can be successfully used to treat children with amblyopia even after the conventional treatment of patching fails.

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