Clinical findings of acute acquired comitant esotropia in young patients

Iimori, Hirohito; Suzuki, Hiroyoshi; Komori, Miwa; Hikoya, Akiko; Hotta, Yoshihiro; Sato, M.

doi:10.1007/s10384-021-00879-9

Cited by 20 publications

(12 citation statements)

References 10 publications

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“…The peak age at onset in our study was 15 years. Iimori et al [ 3 ] investigated patients with AACE aged 5 to 35 years from 2015 to 2018 and found a peak age at onset of 16 years, followed by 15 years, similar to the present study. The rate of increase in the number of patients with AACE was significantly different between elementary students and below and junior high school students and above, with the greatest increase in the number of patients with AACE in junior high school students (12–14 years), and the junior and senior high school students (12–17 years) accounting for about 60% of the cases.…”

Section: Discussionsupporting

confidence: 90%

“…However, the frequency of acute acquired comitant esotropia (AACE) has recently shown an increasing tendency, especially in younger generations. Although AACE has been considered a rare condition, recent reports indicate that excessive use of digital devices can trigger AACE [ 2 , 3 ]. With the widespread use of smartphones and other digital devices, the number of patients with AACE is increasing [ 2 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Yearly changes in cases of acute acquired comitant esotropia during a 12-year period

Okita

Kimura

Masuda

et al. 2023

Graefes Arch Clin Exp Ophthalmol

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Purpose The number of patients with acute acquired comitant esotropia (AACE) has been increasing in Japan. The purpose of this study was to investigate the changes in the number and characteristics of patients with AACE examined in our institution during a 12-year period. Methods We retrospectively reviewed the medical records of patients with AACE aged < 30 years who suddenly developed diplopia or esotropia and were examined in Hyogo College of Medicine Hospital from January 2008 to December 2021. We investigated the association of the yearly changes in the number of patients with the age category, refractive error category, AACE type, esotropia type, and use or nonuse of smartphones. Results The total number of patients with AACE was 171, and this number significantly increased each year (Pearson correlation coefficient, 0.9450; p < 0.0001). Significant increases were found among students in junior high school and beyond, patients with myopia, patients with Bielschowsky type AACE, and patients with basic esotropia (p < 0.0001 for all). We compared two age groups, elementary school students and below versus junior high school students and above, and found that the rate of increase was significantly higher in the junior high school students and above (estimate, 1.951; p < 0.0001), and the non-myopia group and myopia group and found that the rate of increase was significantly higher in the myopia group (estimate, 1.891; p < 0.0001). Excessive use of smartphones was confirmed in 82 of 133 patients, and the rate of the increase in the number of patients with AACE was significantly greater among patients with than without excessive use of smartphones (estimate, 1.098; p = 0.0009). Conclusion This study confirmed a significant increase in the number of patients with AACE in recent years. The excessive use of smartphones may be associated with the increase in AACE.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Yearly changes in cases of acute acquired comitant esotropia during a 12-year period

Okita

Kimura

Masuda

et al. 2023

Graefes Arch Clin Exp Ophthalmol

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“…In addition to a known involvement with intracranial diseases, several other causes have been reported to potentially be connected to the development of AACE, with the majority of the causes associated with the acute accommodative type [3]. Increases in AACE have also been reported to be related to excess digital device usage, which includes smartphones, tablets and computers, with the usage of these devices concomitantly found to have also increased within the last decades [4][5][6][7]. During the Coronavirus disease 2019 (COVID-19) pandemic lockdowns, there was an increase in digital device usage by children due to both studying and playing.…”

Section: Introductionmentioning

confidence: 99%

The effects of topical cycloplegics in acute acquired comitant esotropia induced by excessive digital device usage

Hayashi

Machida

2022

BMC Ophthalmol

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Background Acute acquired comitant esotropia induced by excessive digital device usage, especially smartphones (SAACE), has been increasing over the past few years. One suggested mechanism is convergence spasm induced by excessive near work, with refraining from digital device use considered to be an effective method for decreasing the degree of esodeviation. However, if symptoms persist and are untreated over time, recovery becomes more difficult. The present study evaluated the effects of topical cycloplegics on persistent SAACE untreated for over 1 year. Methods Patients with sustained SAACE that was untreated for over 1 year were evaluated. Digital device usage was discouraged and a topical cycloplegic, 0.4% tropicamide, was prescribed at bedtime. After obtaining informed consent, the 14 out of 23 enrolled patients who agreed to eye drop administration were defined as the study group, with the others serving as the controls. After a 3-month follow-up, patients who elected to undergo surgery were analyzed as the surgery group. Changes in esotropia angles, stereoacuity and diplopia complaints were evaluated after a 3-month follow-up. Results Esotropia angles decreased and stereoacuity improved after a 3-month treatment in the study group (P < 0.01). Diplopia disappeared in 13 patients (92.9%, totally disappeared or disappeared when using glasses with built-in prisms). Among 11 patients with untreated esotropia ranging from 1–3 years, decreases in esotropia angles were correlated to untreated esotropia duration (near: R = -0.6; distance: R = 0.7; both P < 0.05). Esotropia angles in the control group exhibited a tendency to increase while stereoacuity tended to deteriorate after the 3-month follow-up. As diplopia did not disappear in any patients, 7 elected to undergo surgery and were enrolled as the surgery group. While esotropia angles decreased in the study group, they were lower than the surgery group (P < 0.01), but higher than the control group (P < 0.01). Stereoacuity was worse in the control versus the study and surgery groups (both P < 0.05). Conclusion Results suggest short-acting topical cycloplegics are effective in SAACE patients with long untreated periods. Decreases in esotropia angles were negatively correlated to untreated esotropia duration, which suggests the necessity of early treatment.

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“…1,2 The prevalence of AACE has been considered to be rare 3,4 but appears to rise these years in adults. 5 Although several factors such as interruption of fusion, physical or psychological stress, excessive near work with uncorrected myopia and addiction to smart phone has been proposed to be associated with AACE, 1,[5][6][7] the aetiology is still unclear. Nevertheless, surgery is most prescribed treatment for AACE, especially for cases with large angle of deviation.…”

Section: Introductionmentioning

confidence: 99%

Sensory eye dominance following surgically correction for acute acquired concomitant esotropia of adulthood

Shi

Chen

et al. 2022

European Journal of Ophthalmology

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Background Acute acquired concomitant esotropia (AACE) is an unusual presentation characterized by acute onset of esotropia after infancy. For patients with AACE of adulthood, the outcome of surgery, which is a common treatment, often shows successful recovery of stereopsis. However, whether surgically corrected patients with AACE of adulthood achieved balanced eyes is yet unclear. Methods Here, we used a binocular phase combination paradigm to quantitatively assess the ocular dominance of 22 surgically aligned patients with AACE of adulthood, which all had regained normal stereopsis after the surgery and 14 adult controls with normal vision. The sensory eye dominance was quantified as the interocular contrast ratio, termed balance point, at which each eye contributed equally to the perception of cyclopean grating. Results We found that, normal controls had a mean balance point value close to unity (0.96 ± 0.01), whereas adult AACE patients exhibited apparent interocular imbalance (0.76 ± 0.04), which was significantly different from control group (Mann–Whitney U = 135, P < 0.001, two tailed). In addition, the balance point of adults with AACE didn't correlate with the interval between onset of esotropia and the surgery (r = − 0.262, p = 0.239), or the length of postoperative follow-up period (r = 0.127, p = 0.575). Conclusion Our results suggest that, for patients with AACE of adulthood whose eyes had been straightened, there is still residual sensory imbalance which may be a potential risk factor for AACE of adulthood.

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Clinical findings of acute acquired comitant esotropia in young patients

Cited by 20 publications

References 10 publications

Yearly changes in cases of acute acquired comitant esotropia during a 12-year period

Yearly changes in cases of acute acquired comitant esotropia during a 12-year period

The effects of topical cycloplegics in acute acquired comitant esotropia induced by excessive digital device usage

Sensory eye dominance following surgically correction for acute acquired concomitant esotropia of adulthood

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