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Quantification of Oculomotor Responses and Accommodation Through Instrumentation and Analysis Toolboxes
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Outcomes in accommodative esotropia with a high AC/A ratio.

Margaret M Reynolds1, Nancy N Diehl2, Brian G Mohney1

  • 1Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, MN, USA.

European Journal of Ophthalmology
|December 28, 2020
PubMed
Summary

Most children with high accommodative esotropia (AET) and a high AC/A ratio discontinue bifocal use within 10 years. Bifocal use did not improve outcomes or increase surgery likelihood compared to no bifocals.

Keywords:
Strabismus surgery/complicationsepidemiology/biostatisticseso and exo deviationseye movement disorderslens/cataractspecial forms (Duane, CPEO, MG, others)strabismus

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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.