Follow-up monitoring of accommodative esotropia

Purpose: To ascertain an examination interval that will not increase the ri sk of untimely detection of decompensation of accommodative esotropia wheth er or not initial nonoperative treatment must be supplemented. Methods: The records of 63 patients with accommodative esotropia examined at 3- to 6-mo nth intervals were reviewed for the occurrence of decompensation, changes i n refraction, and the need for increased correction of hyperopia or the add ition of bifocals. Results: Decompensation, which was not associated with s ubstantial refractive changes toward or away from emmetropia, occurred in 1 1 patients. No instance of decompensation occurred in the first 12 months o f observation. Although 7 of these decompensated patients were among the 18 (28.6%) requiring supplemental nonoperative treatment, their mean annual r efractive change did not differ significantly from the 11 patients who did not decompensate. Eight (18.6%) of 43 patients first controlled earlier tha n age 48 months later decompensated; 3 (15.0%) of 20 patients with later on set reached this outcome. Conclusions: The monitoring of controlled accommo dative esotropia at intervals of 9 to 12 months is adequate for most patien ts, at least over the first 2 years, with the exception of those requiring treatment for associated conditions such as amblyopia. Refractive error cha nges and the need for supplemental treatment after initial control are not prominently associated with decompensation. Age of onset of accommodative e sotropia earlier or later than 48 months did not influence rapidity of deco mpensation.