Accommodative Esotropia Long Range Follow-up

Thirty-nine adult patients treated for typical (refractive) accommodative esotropia in childhood continue to have problems because they have not outgrown their hypermetropia, and the majority have not developed stable binocular vision. Their hypermetropia became maximal (median 5.7 diopters) by age 6, decreased in adolescence, and then stabilized (median 4 diopters). Thirty-eight of the 39 adults wear correcting lenses full-time. Nearly all depend on relaxed accommodation to maintain alignment when they remove their glasses. Ten patients, all of whom received treatment before a constant esotropia developed are essentially orthophoric with glasses and have normal binocular vision. The remainder have small-angle deviations with glasses, 14 with varying degrees of amblyopia and peripheral fusion and 15 with anomalous correspondence and suppression. As adults, only one patient with normal binocular function has required surgery whereas 13 of the patients lacking normal fusion have had surgery for increasing esotropia, postoperative exotropia, or consecutive exotropia.