Progressive-addition lenses in the treatment of accommodative esotropia

Thirty-two children ranging in age from 18 months to 16 years were treated for accommodative esotropia with variable-focus lenses instead of executive bifocals. The major advantages were the improved appearance of the glasses and the more natural progression of accommodative treatment from distance to near which provided more relaxation of convergence in the intermediate zone. The chief disadvantage was the difficulty fitting small children with lenses that were originally designed for the use of presbyopic adults. The maximum power for the effective control of the deviation for reading is at the bottom of the lens. Keeping this portion of the lens high enough proved to be difficult in small children. None of the patients were willing to return to executive bifocals after having worn progressive-addition lenses.