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The long-term follow-up of accommodative esotropia in a population-based cohort of children
Brian G Mohney1, Chrystia C Lilley, Amy E Green-Simms
1Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. mohney@mayo.edu
Insights
Most children with accommodative esotropia need glasses long-term. Surgery for accommodative esotropia is uncommon, but more likely in boys and those diagnosed earlier.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Research
Background:
- Accommodative esotropia is a common form of strabismus in children.
- Understanding long-term refractive and surgical outcomes is crucial for management.
Purpose of the Study:
- To determine the long-term need for spectacle correction in children with accommodative esotropia.
- To report the rate and predictors of surgical intervention for accommodative esotropia.
Main Methods:
- Retrospective population-based cohort study.
- Reviewed medical records of pediatric patients (<19 years) diagnosed with accommodative esotropia.
- Analyzed spectacle discontinuation rates and surgical intervention rates.
Main Results:
- 306 children diagnosed; 80% had fully accommodative esotropia (FAET).
- Spectacle discontinuation rates were 8% (5 yrs), 20% (10 yrs), and 37% (20 yrs).
- 13.5% of FAET patients underwent surgery; male gender, earlier onset/diagnosis increased likelihood.
Conclusions:
- Majority of children with accommodative esotropia require spectacles into their second decade.
- Surgical intervention for FAET is infrequent but associated with specific patient factors.
Purpose:
To report refractive and surgical outcomes in a cohort of children with accommodative esotropia.
Design:
Retrospective population-based cohort.
Participants:
All pediatric patients (<19 years) diagnosed with accommodative esotropia in Olmsted County, Minnesota, from January 1, 1975, to December 31, 1994.
Methods:
Medical records identified by the Rochester Epidemiology Project were reviewed for spectacle and surgical management.
Main Outcome Measures:
Rate of surgical intervention and discontinuation of spectacles for esotropia.
Results:
A total of 306 children with accommodative esotropia were diagnosed during the study years; 244 (80%) had fully accommodative esotropia (FAET) and 62 (20%) had partially accommodative esotropia (PAET). The Kaplan-Meier rate of discontinuing spectacles for strabismus in this population was 8% by 5 years after diagnosis, 20% by 10 years, and 37% by 20 years. Children born prematurely (P = 0.046) or with a greater initial hyperopic refractive error (P<0.001) were significantly less likely to become spectacle-free during the follow-up period. During a median follow-up of 9.8 years (range, 0-27.9 years), 33 (13.5%) of the 244 subjects with FAET eventually underwent strabismus surgery. Male gender (P = 0.039) and an earlier age at onset (P = 0.008) and diagnosis (P<0.001) of FAET were associated with a higher likelihood of requiring surgery.
Conclusions:
The majority of children with accommodative esotropia in this population continued to require spectacle correction into their second decade of life. A small proportion of children with FAET required surgical intervention, which was more likely to occur among boys and in those with an earlier age at onset and diagnosis of their deviation.
