Predictive factors for long-term outcome of stereoacuity in Japanese patients with pure accommodative esotropia

To find clinical factors related to the long-term outcome of stereoacuity in Japanese patients with pure accommodative esotropia, including both the refractive type and the nonrefractive type.

The medical charts of 19 Japanese patients (8 boys and 11 girls) with pure accommodative esotropia who were followed for 10 years or more at Okayama University Hospital were reviewed retrospectively. Refractive accommodative esotropia was diagnosed in 8 patients while nonrefractive accommodative esotropia was diagnosed in 11 patients. The patients were divided into two groups, based on a stereoacuity of 120 seconds of arc or better versus 240 seconds of arc or worse as measured by the TNO test at the final visit, and the clinical factors were compared between the two groups.

Clinical factors related to a stereoacuity of 240 seconds of arc or worse at the final visit were higher accommodative convergence to accommodation (AC/A) ratios at 6 years of age (p = 0.05), larger residual esodeviations at distance under full correction with glasses at 8 years of age (p = 0.03), and larger residual esodeviations at near at 6 years of age (p = 0.01, Mann-Whitney U-test). Overall, patients with nonrefractive accommodative esotropia tended to show poor levels of stereoacuity at the final visit compared to those with refractive accommodative esotropia (p = 0.059, Fisher exact probability test).

This is the first study of the long-term visual outcome in Japanese patients with pure accommodative esotropia including both refractive and nonrefractive types. To obtain better levels of stereoacuity, the residual esodeviations at near and at distance should be kept as small as possible under full correction with glasses, including bifocals, especially at the ages of 6 and 8 years.