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Amblyopia prevalence in patients with alternating esotropia
Masoud Khorrami-Nejad1, Mohamad Reza Akbari2, Babak Masoomian2
1School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Nearly 20% of children with alternating esotropia develop amblyopia, underscoring the need for careful screening. This finding is crucial for preschool and school-age children undergoing strabismus surgery evaluation.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismology
Background:
- Alternating esotropia, a condition where eyes turn inward, is often considered less likely to cause amblyopia (lazy eye) due to the eyes' ability to alternate fixation.
- However, the actual prevalence of amblyopia in children with this specific type of strabismus requires further investigation, especially in those considered for surgical intervention.
Purpose of the Study:
- To determine the frequency of amblyopia in preschool and school-age children diagnosed with alternating esotropia.
- To assess the relationship between alternating esotropia and the development of amblyopia in pediatric patients.
Main Methods:
- A retrospective, cross-sectional study analyzed preoperative data of 767 children aged 3-10 years with alternating esotropia.
- Exclusion criteria included disabilities, ocular pathologies, craniofacial anomalies, prior surgeries, or vertical deviations.
- Ophthalmic examinations evaluated refractive error, visual acuity, deviation angle, and amblyopia density.
Main Results:
- Out of 767 subjects, 151 (19.7%) had amblyopia, with mild, moderate, and severe forms observed.
- Among amblyopic patients, 24.5% exhibited anisometropia (unequal refractive error between eyes).
- Anisometropia was also present in 5.8% of non-amblyopic participants.
Conclusions:
- Alternating esotropia does not preclude the development of amblyopia in children.
- The significant prevalence of amblyopia in this cohort emphasizes the necessity of thorough ophthalmic assessment for early detection and management.
- Pediatric patients with alternating esotropia require diligent screening for amblyopia, irrespective of surgical candidacy.
Purpose:
To determine the frequency of amblyopia in preschoolers and school-age children with alternating esotropia.
Methods:
This retrospective, cross-sectional, single-center study analyzed the preoperative medical records of patients 3-10 years of age with confirmed alternating esotropia evaluated between 2012 and January 2024. Patients with motor or cognitive disabilities, ocular pathologies, or craniofacial anomalies were excluded, as were those with prior ocular surgeries or vertical deviations. Comprehensive ophthalmic examinations assessed refractive error, visual acuity, angle of deviation, and density of amblyopia.
Results:
A total of 767 subjects (mean age, 6.9 ± 1.8 years; 41.4% female) with alternating esotropia were included. Of these, 151 (19.7%) were diagnosed with varying degrees of amblyopia: mild in 87 patients (57.6%), moderate in 60 (39.8%), and severe in 4 (2.7%). Thirty-seven of the amblyopic patients (24.5%) showed evidence of anisometropia; specifically, 32 (21.2%) had anisohyperopia, 4 (2.7%) had anisomyopia, and 1 (0.7%) had anisoastigmatism. Of the 616 nonamblyopic participants, 36 individuals (5.8%) had anisometropia.
Conclusions:
The alternating nature of esotropia does not necessarily ensure the absence of amblyopia in children who are candidates for strabismus surgery. The high prevalence of amblyopia highlights the importance of thorough assessment and careful attention to the detection of amblyopia in this patient population.
