The Role of Dynamic Retinoscopy in Predicting Infantile Accommodative Esotropia and Influencing Emmetropization

Abstract

Normal accommodation on dynamic retinoscopy in orthotropic hyperopic infants is a predictor of continued good alignment and such infants can be followed without spectacles. Partial spectacle correction based on dynamic retinoscopy may have a beneficial effect on reducing the development of strabismus without impeding emmetropization. Early binocular accommodative behavior seems to be predictive of infants at risk of developing strabismus.

The Importance of the Interaction Between Ocular Motor Function and Vision During Human Infancy

“…If so, then those who did not accommodate to focus their retinal images would remain aligned. Data collected to date have consistently suggested the reverse (Ingram et al 1994, Somer et al 2018. Children with significant hyperopia who accommodate more accurately tend to remain aligned, whereas those who underaccommodate are more likely to develop strabismus.…”

“…For example, appealing candidates include forms with relatively late onset that may be related to refractive error (e.g., refractive esotropia and anisometropic amblyopia), as opposed to those that appear earlier (e.g., infantile esotropia) with as-yet poorly understood etiology (e.g., infantile esotropia or intermittent exotropia). Disappointingly, the first studies that provided glasses correction to hyperopic infants at risk for refractive esotropia had mixed success in the prevention of strabismus (Anker et al 2004, Atkinson et al 1996, Ingram et al 1990, Jones-Jordan et al 2014, suggesting that preventative approaches may need to be more complex (Babinsky & Candy 2013, Somer et al 2018).…”

“…Others appear associated with optical characteristics of the eye, for example, refractive esotropia associated with significant hyperopia, sensory strabismus that develops after a congenital cataract, or perhaps microstrabismus associated with anisometropia. Although the latter forms could also have a more central neural component, an exciting task for basic and clinical vision science is to determine whether visual experience can be manipulated during infancy and early childhood to encourage both emmetropization and the prevention of some forms of strabismus and amblyopia (Abrahamsson & Sjostrand 1996, Anker et al 2004, Atkinson et al 1996, Ingram et al 1990, Jones-Jordan et al 2014, Somer et al 2018).…”

“…This question is not trivial to address, as prospective studies of the development of strabismus involve recruiting and tracking many infant participants (the combined prevalence of all forms of strabismus is approximately 2-3%) (Friedman et al 2009). The ethics of providing interventions such as glasses designed to prevent strabismus are also ambiguous in the absence of a deep understanding of this condition that impacts only approximately 20% of significant hyperopes (Somer et al 2018). Current clinical guidelines suggest providing optical correction for hyperopia greater than 4.50-6.00 D in the absence of strabismus during infancy and early childhood, but they are based solely on clinical consensus in the absence of definitive evidence (Wallace et al 2018).…”

<p>Performance of Glow Fixation GoCheck Kids and 2WIN Photoscreeners and Retinomax to Uncover Hyperopia</p>

“…4 Excess hyperopia, usually more than +3.50 diopters can produce amblyopia if the child does not sufficiently accommodate, 5 or if the excess accommodation produces esotropia. 6,7 Photoscreeners attempt to identify children at risk for amblyopia by uncovering excess hyperopia and/or esotropia. Several different photoscreener methods of eliciting fixation and/or accommodation have been utilized by different manufacturers.…”