Clinical course of accommodative esotropia.

PURPOSE: To report the clinical course of patients having accommodative esotropia and to determine whether the strabismus resolves during the adolescent years.

METHODS: Patients diagnosed with accommodative esotropia from 1983 to 1991 were recalled to the clinic for re-examination. For all patients, the clinical records indicated that the esotropia had begun in early childhood and was controllable at some time during the follow-up period with plus power single vision glasses and/or bifocals. Re-examination included assessment of patient history, visual acuity, ocular alignment, versions, sensory fusion, and refractive error. The ocular alignment status with and without any current plus single vision and/or bifocal correction, and the refractive error at recall, were compared to the same findings taken at the patient's initial clinic visit. These findings were compared to determine whether the accommodative esotropia had resolved, improved, remained the same, or increased in amount.

RESULTS: Thirty-nine patients participated in the study. At the time of recall their average age and follow-up period were 16.8 and 9.5 years, respectively. Before treatment, the mean eso deviation was 14.5 delta at distance and 21.6 delta at near. At recall, 15 patients used single vision glasses, 9 used glasses with bifocals, 11 used contact lenses, and 4 patients used no optical correction. Five patients (12.8%) had best corrected acuity in one eye of 20/30 or poorer. Twenty patients (57.1%) were not strabismic with their current refractive correction, whereas 15 patients (42.8%) continued to be esotropic (intermittent or constant) at distance and/or near. When assessing ocular alignment without the current plus power correction, 26 patients (82%) were esotropic and 4 patients (15.6%) were heterophoric. The mean deviation without the optical correction was 18.6 delta at distance and 19 delta at near. Of the 4 patients presenting without an optical correction, 3 were esotropic at distance and/or near and 1 patient was heterophoric. Six patients (15.3%) also had inferior oblique overaction, 2 which occurred with superior oblique palsy. Thirty-three patients (86.8%) fused the Worth dot test at distance and/or near, and 35 patients (89.7%) had stereopsis (mean, 84 sec arc). The mean spherical equivalent refractive error changed for the group from 2.77 D hyperopia at the initial evaluation to 1.95 D hyperopia at recall (mean refractive shift = -0.08 D/year).

CONCLUSIONS: Accommodative esotropia persists for most patients into adolescence and early adulthood. These patients need to be carefully monitored during this period because most do not outgrow their hyperopia and some can again become esotropic.