Single-vision lenses: a comparison of management of high AC/A esotropia and refractive esotropia

Management of high AC/A includes bifocal lenses, single-vision distance lenses, and surgery. Our goal was to determine the long-term outcome of single-vision lenses (SVL) for high AC/A esotropia compared with normal AC/A ET.

This retrospective study included patients with accommodative esotropia managed with SVL and a minimum 5 years of follow-up. AC/A ratio, size and control of esotropic angle, stereopsis, refractive error, and ability to control the deviation while the prescription was being weaned were measured. A study group with high AC/A esotropia was compared with a control group with refractive esotropia and a normal AC/A ratio.

A total of 36 patients were enrolled in this study: 22 in the study group and 14 in the control group. All patients in both groups showed improvement in at least one outcome category. One patient showed deterioration in only one category.

High improvement and low deterioration rates suggest that SVL are an effective treatment for high AC/A esotropia. Because there was no bifocal comparison group we cannot determine if SVL are equally effective. The results do indicate that SVL are an acceptable form of treatment for patients with high AC/A esotropia.