Is the maximum hypermetropic correction necessary in children with fully accommodative esotropia?

AIMS: This prospective study explores the effect of reduction in hypermetropic refractive correction on the angle and control of fully accommodative esotropia.

METHODS: 30 childhood cases with fully accommodative esotropia were recruited. The angle of deviation with and without full hypermetropic correction (near and distance) was measured. The overall effect of reduction of the correction by one and two spherical dioptres (DS) on the angle and control of the deviation was identified.

RESULTS: With the full hypermetropic correction in place, the angle of deviation for near was less than 10 prism dioptres (pd) in 73% of the participants, and the distance deviation was less than 10 pd in 93%. When the prescription was reduced by 1.00 DS, the percentage of those with a near deviation of less than 10 pd fell to 30% and 57% for the distance. Twenty per cent immediately decompensated to manifest esotropia with reduction of 1 dioptre of spectacle correction.

CONCLUSION: Children with fully accommodative esotropia who are given the full hypermetropic correction demonstrate smaller, more controllable angles of deviation than those who are undercorrected by as little as only one dioptre. This supports the practice of providing the maximum hypermetropic correction for childhood esotropes.