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Accommodative ET-High AC/A Ratio Esotropia: The Case for Glasses.

Edward L Raab1

  • 1From the Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York. eraabmdjd@aol.com.

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|November 2, 2016
PubMed
Summary

Treating near over-convergence in patients with distance alignment within 8 prism diopters is debated. Full cycloplegic correction with bifocals is preferred to manage accommodation and prevent muscle alterations.

Keywords:
abnormal distance-near alignment comparison, hypoaccommodation, bifocalsaccommodative esotropia, high AC/A ratio

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Area of Science:

  • Ophthalmology
  • Binocular Vision
  • Strabismus

Background:

  • Debate exists on treating persistent near over-convergence in patients with distance alignment within 8 prism diopters.
  • The efficacy and necessity of interventions for this specific patient group remain unclear.

Purpose of the Study:

  • To discuss treatment strategies for patients with residual distance misalignment and near over-convergence.
  • To evaluate the potential consequences of prolonged convergence tone and accommodative demand.

Main Methods:

  • Preference for full cycloplegic correction combined with a bifocal prescription.
  • Initial discouragement of accommodation, with subsequent gradual reduction of the bifocal effect.
  • Review of existing literature regarding treatment outcomes and potential complications.

Main Results:

  • Lack of consensus persists on whether this approach causes accommodative issues like disuse weakening or premature presbyopia.
  • Prolonged near convergence tone can lead to medial rectus muscle alterations, potentially compromising distance alignment.
  • Hypoaccommodative esotropia shares characteristics with high AC/A (accommodative convergence/accommodation ratio) esotropia.

Conclusions:

  • Spontaneous resolution of near over-convergence is unlikely in hypoaccommodating patients with observation or surgery alone.
  • Surgery is reserved for rare cases with significant distance-near disparity or in older patients unlikely to resolve.
  • Management requires careful consideration of accommodative function and potential long-term effects on binocular vision.