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Refractive change in children with accommodative esotropia.

Lucas Bonafede1, Lloyd Bender1, James Shaffer2

  • 1Department of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

The British Journal of Ophthalmology
|December 7, 2019
PubMed
Summary

Hyperopia in children with accommodative esotropia may increase before age 7, then gradually decreases by age 15. This refractive change occurs regardless of initial hyperopia levels or esotropia type.

Keywords:
child health (paediatrics)

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Area of Science:

  • Ophthalmology
  • Pediatric Ophthalmology
  • Refractive Errors

Background:

  • Accommodative esotropia is a common form of strabismus in children.
  • Hyperopia is often associated with accommodative esotropia.
  • Understanding refractive error changes over time is crucial for managing this condition.

Purpose of the Study:

  • To investigate the longitudinal changes in hyperopia among children diagnosed with accommodative esotropia.
  • To determine if refractive error progression differs based on baseline hyperopia or esotropia type.

Main Methods:

  • Retrospective cohort study of children with accommodative esotropia diagnosed before age 7.
  • Analysis included at least two cycloplegic refractions before age 7 and after age 10.
  • Linear mixed-effect models were used to calculate annual refractive change, with subgroup analyses.

Main Results:

  • Overall annual refractive error change was -0.071 D/yr.
  • Hyperopia increased (0.12 D/yr) in children with <4D baseline hyperopia before age 7, but was stable in those with ≥4D.
  • From ages 7 to 15, hyperopia decreased by approximately -0.17 to -0.18 D/yr in both baseline groups, with no significant difference between fully or partially accommodative esotropia.

Conclusions:

  • Hyperopia in children with accommodative esotropia is dynamic, potentially increasing in early childhood and decreasing in later childhood and adolescence.
  • Refractive error progression is influenced by initial hyperopia levels up to age 7.
  • Management strategies may need to consider these age-related refractive changes.