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High AC/A ET: Bifocals? Surgery? Or Nothing at All?

Kyle Arnoldi, Marla Shainberg

The American Orthoptic Journal

|December 15, 2010

Summary

Surgery, bifocals, or single vision lenses for accommodative esotropia all show long-term success in about one-third of patients. Surgery offers earlier success but may reduce stereoacuity, while lenses offer comparable outcomes without impacting binocular vision.

Area of Science:

Ophthalmology
Pediatric Ophthalmology
Strabismus Management

Background:

Bifocals are the historical standard for pure high AC/A esotropia, but surgery is increasingly common.
A long-term comparative study with a control group for these treatments was lacking.

Purpose of the Study:

Compare bifocals, surgery, and single vision lenses for accommodative esotropia.
Evaluate effects on near angle, distance-near disparity, AC/A ratio, binocular vision, and refractive error over five years.

Main Methods:

Prospective study of patients with pure high AC/A esotropia.
Treatment options included surgery, bifocals, or single vision hyperopic lenses.
Minimum five-year follow-up with sensorimotor exams and cycloplegic refraction.

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Main Results:

Bifocals and single vision lenses reduced near esotropia by 5Δ without changing gradient AC/A; bifocals were linked to less emmetropization and increased AC/A over time.
Surgery significantly reduced the near angle and distance-near disparity, but AC/A reduction was temporary, and stereoacuity loss was higher than in other groups.
Approximately one-third of patients in each group achieved long-term success, with earlier success in the surgery group.

Conclusions:

All three treatments can be effective for accommodative esotropia.
Each treatment has distinct advantages and potential adverse effects.
Treatment choice should be individualized based on patient circumstances.