Outcome in refractive accommodative esotropia

Aim-To examine outcome among children with refractive accommodative esotrop ia. Methods-Children with accommodative esotropia associated with hyperopia wer e included in the study. The features studied were ocular alignment, amblyo pia, and the response to treatment, binocular single vision, requirement fo r surgery, and the change in refraction with age. Results-103 children with refractive accommodative esotropia were identifie d. Mean follow up was 4.5 years (range 2-9.5 years). 41 children (39.8%) we re fully accommodative (no manifest deviation with full hyperopic correctio n). The remaining 62 children (60.2%) were partially accommodative. At pres entation 61.2% of children were amblyopic in one eye decreasing to 15.5% at the most recent examination. Stereopsis was demonstrated in 89.3% of child ren at the most recent examination. Mean cycloplegic refraction (dioptres, spherical equivalent) remained stable throughout the follow up period. The mean change in refraction per year was 0.005 dioptres (D) in right eyes (95 % CL -0.0098 to 0.02) and 0.001 D in left eyes (95% CL -0.018 to 0.021). No patients were able to discard their glasses and maintain alignment. Conclusions-Most children with refractive accommodative esotropia have an e xcellent outcome in terms of visual acuity and binocular single vision. Cur rent management strategies for this condition result in a marked reduction in the prevalence of amblyopia compared with the prevalence at presentation . The degree of hyperopia, however, remains unchanged with poor prospects f or discontinuing glasses wear. The possibility that long term full time gla sses wear impedes emmetropisation must be considered. It is also conceivabl e, however, that these children may behave differently with normal and be p redestined to remain hyperopic.