Authors
RUTSTEIN, ROBERT P. OD, MS, FAAO; MARSH-TOOTLE, WENDY OD, MS, FAAO

Clinical Course of Accommodative Esotropia

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Abstract/Introduction

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.


Conclusion/Results

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 14.5δ at distance and 21.6δat 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 18.6δ at distance and 19δ 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.


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Testimonials


My eight year old daughter was terrified to go to the eye doctor for fear of her eyes being dilated. The doctor was SO KID friendly! He immediately made her comfortable by engaging her in conversation. It was a geat experience.


Joya B.

Dr. Garbus spent an amazing amount of time to solve my very complicated visual problems. Over the years he has continually achieved results beyond what others felt possible. He is always up to date on the latest science. He is great!


Dolores K.

Family Vision Care Valencia makes it so easy. Staff is knows what they are doing and Dr. Garbus is thorough and kept me well informed during the exam.


Kristy B.

I have been coming to Family Vision Center for almost 20 years. Dr. Garbus has been able to help my vision when other doctors could not. Now my kids see him as well. I highly recommend this office!


Autumn C.

The Doctor is very good. I felt on this visit he seemed rushed. I had questions to ask him but he was already with another patient. I still do not know if my eyes are the same , worse, or better.


Howard B.

All the staff is friendly, helpful and knowledgeable, and has been for all the years I have been going there.


Mary Ann H.
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