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Outcome in refractive accommodative esotropia

Outcome in refractive accommodative esotropia,Alan Mulvihill,Aoife MacCann,Ian Flitcroft,Michael O'Keefe

Outcome in refractive accommodative esotropia   (Citations: 6)
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Aim—To examine outcome among chil- dren with refractive accommodative es- otropia. Methods—Children with accommodative esotropia associated with hyperopia were included in the study. The features studied were ocular alignment, amblyopia, and the response to treatment, binocular sin- gle vision, requirement for surgery, and the change in refraction with age. Results—103 children with refractive ac- commodative esotropia were identified. Mean follow up was 4.5 years (range 2-9.5 years). 41 children (39.8%) were fully accommodative (no manifest deviation with full hyperopic correction). The re- maining 62 children (60.2%) were par- tially accommodative. At presentation 61.2% of children were amblyopic in one eye decreasing to 15.5% at the most recent examination. Stereopsis was demon- strated in 89.3% of children at the most recent examination. Mean cycloplegic re- fraction (dioptres, spherical equivalent) remained stable throughout the follow up period.The mean change in refraction per year was 0.005 dioptres (D) in right eyes (95% CL ˛0.0098 to 0.02) and 0.001 D in left eyes (95% CL ˛0.018 to 0.021). No patients were able to discard their glasses and maintain alignment. Conclusions—Most children with refrac- tive accommodative esotropia have an excellent outcome in terms of visual acuity and binocular single vision. Cur- rent management strategies for this con- dition result in a marked reduction in the prevalence of amblyopia compared with the prevalence at presentation. The de- gree of hyperopia, however, remains un- changed with poor prospects for discontinuing glasses wear. The possibility that long term full time glasses wear impedes emmetropisation must be con- sidered. It is also conceivable, however, that these children may behave diVerently with normal and be predestined to remain hyperopic. (Br J Ophthalmol 2000;84:746-749)
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