Sensory outcome with nonsurgical management of esotropia with convergence excess (a high accommodative...

Twenty-seven patients with esotropia and convergence excess (a high accommodative convergence/accommodation [AC/A] ratio) managed nonsurgically underwent a final standardized evaluation of their sensory and motor status after a follow-up period of at least 8 years. All had a deviation with distance fixation of less than 10 prism dioptres (PD) of esotropia with full optical correction both initially and throughout the follow-up period. The average spherical-equivalent refractive error was +2.3 D. The AC/A ratio had tended to decrease with age, and most patients had fusion, although only a small proportion had central fusion and stereopsis. Approximately half of the patients had been treated with bifocals, but their sensory outcome did not differ from that of the other patients. Miotics had not been used for more than a few months in any patient, as they were ineffective in reducing the deviation with near fixation to less than 10 PD of esotropia. A study, possibly a multicentre one, involving larger numbers of patients should be designed to find out whether bifocal therapy offers an advantage in the final sensory outcome of such patients.