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Ultranear testing in accommodative esotropia.

R A Saunders, S E Morse, J P Cornetet

    The American Orthoptic Journal
    |December 15, 2010
    PubMed
    Summary
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    Children with accommodative esotropia controlled by glasses may develop eye misalignment at very close viewing distances. This suggests excess accommodation may contribute to convergence issues in these patients.

    Area of Science:

    • Ophthalmology
    • Pediatric Ophthalmology
    • Strabismus

    Background:

    • Accommodative esotropia is a common form of strabismus in children.
    • Spectacle correction typically controls ocular alignment in these patients.
    • The effect of very near viewing distances on alignment in treated accommodative esotropia is not well understood.

    Purpose of the Study:

    • To investigate ocular alignment in children with accommodative esotropia when viewing at distances closer than 1/3 meter.
    • To assess if spectacle correction maintains alignment at ultranear viewing distances.

    Main Methods:

    • A prospective case-control study design was employed.
    • Thirty children diagnosed with refractive accommodative esotropia were evaluated.
    • Ocular alignment was measured at 6 meters, 1/3 meter, and 1/6 meter (ultranear) using accommodative targets; 10 controls without strabismus were included.

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    Main Results:

    • 93% of children with accommodative esotropia showed a manifest deviation (5-16 prism diopters) at ultranear distances.
    • Excessive accommodation was suspected in some patients.
    • Control subjects maintained ocular alignment across all tested distances (P <0.0001).

    Conclusions:

    • Children with refractive accommodative esotropia exhibit significant excess convergence at very close viewing distances.
    • Excess accommodation is a potential contributing factor to this observed deviation.