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Updated: Mar 25, 2026

Using an Automated Hirschberg Test App to Evaluate Ocular Alignment
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Early alignment versus delayed alignment in patients with hyperopia and esotropia.

Kyung-Ah Park1, Sei Yeul Oh1

  • 1Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|February 27, 2016
PubMed
Summary

Early spectacle correction for esotropia in hyperopic patients improves stereoacuity. However, some patients achieve alignment without surgery, even with initial poor alignment, suggesting a need for careful counseling.

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Area of Science:

  • Ophthalmology
  • Pediatric Ophthalmology
  • Strabismus Management

Background:

  • Hyperopia and esotropia often coexist in pediatric patients.
  • Timely intervention is crucial for optimal visual development in strabismus.

Purpose of the Study:

  • To compare clinical outcomes in hyperopic patients with esotropia based on early versus delayed alignment after spectacle correction.
  • To evaluate the impact of early intervention on final stereoacuity.

Main Methods:

  • Retrospective review of 136 hyperopic patients with esotropia treated with spectacles.
  • Patients were categorized into early-alignment (≤10Δ residual esotropia at 2 months) and delayed-alignment (>10Δ) groups.
  • Primary outcome measure was final stereoacuity.

Main Results:

  • The early-alignment group showed a higher proportion of patients with high-grade stereoacuity (≤100 arcsec) compared to the delayed group (37% vs 19%).
  • Overall stereoacuity was significantly better in the early-alignment group (P=0.037).
  • Approximately 70% of patients with poor early alignment required surgery, while 30% improved spontaneously with spectacles alone over one year.

Conclusions:

  • Earlier correction of esotropia in hyperopic children is associated with better final stereoacuity.
  • A significant portion of patients with initially poor alignment may achieve satisfactory outcomes without surgery, necessitating careful consideration during parental counseling regarding surgical interventions.