High AC/A Ratio Esotropia: Do We Really Need to Be Using Bifocals?

Most strabismus specialists use bifocals for patients with convergence excess esotropia whose distance deviation is small. While this is a popular treatment modality, there is actually no good data to indicate that this should be considered a standard of care.

In patients for whom the distance deviation is small enough to allow for the development of binocular vision, my preference is to simply observe these patients. Most will improve with time. For those who do not, or who decompensate, surgery may be indicated.

A careful review of the literature shows a lack of evidence to suggest that bifocals provide an effective treatment for this problem. Some data and theoretical concern may raise a concern over their use. Time and observation may be all that is necessary. There may be a role for surgical correction in these patients as well.

While there are theoretical advantages to the use of bifocals in patients with convergence excess esotropia, current data does not support the actual need for active treatment of these patients.