Outcomes in accommodative esotropia with a high AC/A ratio

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Strabismus Management

Background:

• Accommodative esotropia (AET) is a common form of strabismus in children.
• A high AC/A ratio indicates a strong link between focusing effort and eye turning.
• Understanding treatment outcomes for AET with a high AC/A ratio is crucial for clinical practice.

Purpose of the Study:

• To evaluate the long-term outcomes of high AC/A ratio accommodative esotropia in children.
• To assess the effectiveness and discontinuation rates of bifocal treatment in this population.

Main Methods:

• Retrospective cohort study of children (<19 years) diagnosed with AET and high AC/A ratio.
• Data collected from medical records spanning 30 years (1975-2004) in Olmsted County, MN.
• Analysis of bifocal discontinuation, strabismus surgery rates, and stereoacuity outcomes.

Main Results:

• Of 106 patients with high AC/A ratio AET, 93 were managed with bifocals.
• Over half (53.8%) of patients discontinued bifocals within a mean of 58.7 months.
• Bifocal discontinuation was more common in patients who had strabismus surgery.
• Bifocal use did not significantly impact stereoacuity or the likelihood of requiring surgery compared to non-users.

Conclusions:

• The majority of children with high AC/A ratio AET discontinue bifocal use within 10 years.
• Strabismus surgery is associated with a higher rate of bifocal discontinuation.
• Bifocal treatment in this cohort did not lead to improved stereoacuity or a reduced need for surgery.