Accommodative Esotropia Who Needs Spectacles for Good Ocular Alignment after Refractive Shift below +2.00 Diopters

Abstract

Purpose: The aim of this study is to investigate the clinical characteristics of patients diagnosed with refractiveaccommodative esotropia (RAE) whose refractive errors were gradually reduced to below +2.00 diopters (D)during follow-up but use of spectacles was still required for maintenance of good ocular alignment. Methods: We conducted a retrospective review of the medical records of patients diagnosed with RAE from1995 to 2011. Patients were divided into 2 groups according to their ocular alignment at the last visit. Inclusioncriteria were hyperopia ≥+2.00 D detected with cycloplegic refraction at the initial visit, which then becamemild hyperopia (<+2.00 D) or myopia during follow-up, with more than 5 years of follow-up. Results: A total of 92 patients met the inclusion criteria. Twenty-six patients showed persistent esotropia (≥10 prismdiopters [PD]) without spectacles (group A) and 66 patients showed good ocular alignment (<10 PD) withoutspectacles (group B) at the last visit. No statistically significant differences in the spherical equivalent of therefractive errors at the initial and last visit were observed between the two groups. A significantly lower number ofpositive responses on the Lang I stereotest was observed in group A (n = 1, 3.8%) compared to group B (n = 22,33.3%) (p = 0.003). There were increasing trends toward group A with worsening stereoacuity measured by theStereo Fly Stereotest between the two groups (p = 0.016, linear by linear association). The results of the Lang Itest, Stereo Fly Stereotest, and duration between the onset of esotropia and prescribing spectacles showed asignificant association with the discontinuation of spectacles in the univariate logistic analysis. Conclusions: Stereoacuity showed more significant associations than refractive errors in RAE with refractiveerror <+2.00 D but still required spectacles for maintenance of good ocular alignment. The prompt treatmentof accommodative esotropia at the onset of esotropia is important for the discontinuation of spectacles.