A data-driven approach to the management of accommodative esotropia

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Strabismus

Background:

• Accommodative esotropia is a common form of strabismus in children.
• Determining the optimal treatment strategy is crucial for achieving functional alignment and preventing amblyopia.

Purpose of the Study:

• To identify key initial examination findings that predict the ability to achieve and maintain functional alignment in children with accommodative esotropia.
• To assess the likelihood of success with single-vision spectacles, bifocals, or surgery.

Main Methods:

• Retrospective, observational case series of 68 consecutive patients with accommodative esotropia.
• Exclusion criteria included prior spectacle use, ocular pathology, or surgery, and follow-up less than 2 years.
• Main outcome measure was the achievement of functional alignment (residual esotropia < 8 prism diopters).

Main Results:

• Significant differences were observed in age at spectacle prescription, cycloplegic refractive error, amblyopia, and uncorrected near and distance deviations between children who achieved alignment and those who did not.
• A prediction model identified amblyopia, uncorrected distance deviation, cycloplegic refractive error, and age at spectacle prescription as significant predictors of achieving orthotropia with single-vision spectacles.
• The model demonstrated high sensitivity (94%) and specificity (91%) for predicting successful outcomes with single-vision spectacles.

Conclusions:

• Clinical presentations vary significantly among children with accommodative esotropia, influencing the choice between single-vision spectacles, bifocals, or surgery.
• An evidence-based predictive algorithm can assist practitioners in selecting the most appropriate intervention for individual children.