Clinical evaluation of cessation of hyperopia in 123 children with accommodative esotropia treated with glasses for best corrected vision

Abstract

ABSTRACT.Purpose: This study aimed to determine age at successful cessation of hyperopic glasses, the influence of hyperopia on the esotropic angle and age at discontinuation of glasses in accommodative esotropia (AE) patients. Methods: We performed a retrospective study in 123 AE patients who achieved complete emmetropization and maintained orthophoria without hyperopic glasses between March 1999 and February 2005. All patients had been prescribed the weakest possible glasses to provide best corrected vision and maintain fusion in hyperopia. Results: Pure AE was found in 64 patients and partial AE in 59. At the initial visit, 56.1% of patients had refractive errors of 3.00)5.00 D (mean cycloplegic spherical equivalent [SE]). The angle of esotropia without correction was 30.90 ± 14.80 prism dioptres (PD) (mean ± standard deviation) in pure AE, and 42.70 ± 15.19 PD in partial AE (p = 0.000). The non-accommodative component in partial AE was 24.07 ± 14.90 PD. The mean age at cessation of glasses use was 13.50 ± 3.81 years. Stereopsis was noted in 70.2% of patients at the initial visit and 96.4% at the last visit. Pearson's correlation coefficients (r) were 0.480 between the degree of hyperopia and amount of optically corrected esotropia (p = 0.000), and 0.434 between the degree of hyperopia and age at successful cessation of corrective glasses use (p = 0.000). Conclusions:The mean age at resolution of hyperopia with good stereopsis was 13.5 years. The degree of hyperopia seemed to correlate with the angle of esotropia and the age of successful cessation of corrective glasses.

Changes in refractive error in patients with accommodative esotropia after being weaned from hyperopic correction

“…Several reports have been published regarding safe undercorrection in AET 11–13 22–24. We previously reported a study on patients with AET who achieved emmetropisation and maintained orthotropia without hyperopic glasses, and the subjects had been prescribed the weakest hyperopic glasses to provide best corrected vision and maintain fusion and not full hyperopic correction 13. Consequently, they were able to discontinue wearing hyperopic glasses at an average age of 13.5 years.…”

“…The myopic progression rate per year in AET has been reported to vary widely 4 9–11 13 18 20. Mulvihill et al 18 observed myopic progression rates of 0.005 D/year in the right eye and 0.001 D/year in the left eye.…”

“…We retrospectively reviewed the medical records of all 123 patients with AET who achieved emmetropisation and orthophoria without hyperopic glasses in the previous study;13 of those patients, 92 were followed for at least 3 years. Of those 92 patients, refractive AET was observed in 47 patients and partial AET was observed in 45 patients.…”

“…However, some studies that performed active weaning from hyperopic glasses revealed that 60% of patients with AET were able to discontinue wearing hyperopic glasses 11 12. We previously published a study on the clinical results of hyperopia and esotropia (ET) resolution in 123 patients with AET who wore hyperopic glasses to achieve the best corrected vision 13. The subjects were able to successfully discontinue wearing hyperopic glasses at an average age of 13.5 years (6.5–26 years), and the degree of hyperopia was correlated with the age of emmetropisation with AET.…”

Do Amblyopic Eye First, Wait and Do Second Eye Cataract Surgery for Isoametropia, Accomodative Esotropic Amblyopia and Congenital Cataract Case

“…Approximately 50% of all pediatric esotropias are either entirely or partly accommodative and correction of high hypermetropia with glasses is the primary treatment for accommodative esotropia [13]. Prescription of the full amount of hyperopic correction provides adequate treatment for accommodative esotropia in 75% of cases [14]. Unfortunately these glasses are often poorly accepted by adolescents and young adults for they are cosmetically undesirable, heavy, and esotropia occurs with their removal.…”