The deterioration of accommodative esotropia: frequency, characteristics, and predictive factors

A number of patients with accommodative esotropia who are initially well controlled in their spectacle correction will deteriorate. To obtain an overall estimate of the prevalence of deterioration and to examine the associated clinical features for an indication of which factors may influence deterioration, 114 charts of patients with the diagnosis of accommodative esotropia, who were followed for a period of at least 10 years, were reviewed. Results of this review showed that 15 of the 114 patients (13%) deteriorated. Overall, 73 patients had a normal AC/A ratio (viz less than 5:1 by the gradient method) and 41 patients had a high AC/A ratio; deterioration occurred in statistically identical proportions in each group. There was an increasing frequency of deterioration the longer the delay between the onset of esodeviation and prescription of optical correction. In addition, deterioration was found to be most prevalent in patients for whom the age of onset was 24 months or younger. Other parameters were consistent with features typically reported in cases of accommodative esotropia.