Long-term development of refractive error in refractive, nonrefractive and partially accommodative esotropia

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Strabismology

Background:

• Accommodative esotropia (AE) is a common childhood strabismus linked to hyperopia and excessive accommodation.
• While hyperopia development is known, comparative analyses across AE subtypes are lacking to understand distinct refractive error progression patterns.
• This study addresses the need for comparative analysis of long-term refractive error changes in different forms of AE.

Purpose of the Study:

• To investigate and compare the long-term refractive error development in patients with refractive (RAE), non-refractive (NRAE), and partially accommodative esotropia (PAE).
• To analyze refractive error changes from childhood to adulthood (approx. 4 to 20 years) in AE subtypes while wearing full refractive correction.

Main Methods:

• Retrospective review of medical records for 66 patients diagnosed with AE (24 RAE, 22 PAE, 20 NRAE).
• Analysis of refractive error variations over a mean follow-up of 16 years, comparing AE subtypes.
• Investigation of factors including hyperopia severity, amblyopia, and AC/A ratio on refractive error progression.

Main Results:

• All AE subtypes exhibited a similar non-linear refractive error trend: initial hyperopic increase followed by a decrease into adulthood.
• Refractive AE (RAE) showed a significantly slower mean annual decrease in spherical equivalent (-0.07D) compared to NRAE (-0.11D) and PAE (-0.13D).
• Despite trends, significant hyperopia remained at the final examination, with no significant overall change from baseline across groups; AC/A ratio, amblyopia, and initial hyperopia did not significantly influence longitudinal refractive error changes.

Conclusions:

• Refractive error development in accommodative esotropia follows a consistent non-linear pattern from childhood to adulthood across RAE, PAE, and NRAE subtypes.
• While refractive error trends are similar, RAE demonstrates a slower rate of spherical equivalent decrease compared to other AE forms.
• The study provides a comprehensive overview of long-term refractive error changes in AE, highlighting the persistence of hyperopia and the limited impact of associated factors on progression patterns.