Comparison of Clinical Features in Refractive Accommodative Esotropia According to the Presence of Anisometropia

Nang Hee Song; Dae Hyun Kim

doi:10.3341/jkos.2013.54.2.317

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Song and Kim: Comparison of Clinical Features in Refractive Accommodative Esotropia According to the Presence of Anisometropia

Original Article

J Korean Ophthalmol Soc 2007;54(2):317-323.

Published online: 24 August 2007

DOI: https://doi.org/10.3341/jkos.2013.54.2.317

Comparison of Clinical Features in Refractive Accommodative Esotropia According to the Presence of Anisometropia

Nang Hee Song, MD, Dae Hyun Kim, MD, PhD

Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Korea

Address reprint requests to Dae Hyun Kim, MD, PhD Department of Ophthalmology, Chosun University Hospital #365 Pilmun-daero, Dong-gu, Gwangju 501-717, Korea Tel: 82-62-220-3190, Fax: 82-62-225-9839, E-mail: eyelovehyun@hanmail.net

Received 10 March 201218 October 2012 Accepted 21 December 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the clinical features according to the presence of anisometropia in refractive accommodative esotropia patients.

Methods

Forty-five refractive accommodative esotropia patients were divided into 2 groups : patients who had anisometropia of more than 1.00D (anisometropia group), and patients who had anisometropia of less than 1.00D (isometropia group). Age at onset, age when glasses were first worn, the initial and final angle of esotropia with or without hyperopic correction, the recovery time to orthophoria after hyperopic correction, the degree of stereoacuity and the frequency of amblyopia, the prevalence of deterioration, and the ratio of accommodative-convergence to accommodation were retrospectively reviewed.

Results

There were no statistical differences between the 2 groups in the frequency of amblyopia, the prevalence of deterioration, and the ratio of accommodative-convergence to accommodation at the initial and final visit. The angles of deviation with hyperopic correction at the 1-month follow-up visit in the anisometropia group and the isometropia group were 8.80 ± 5.63 PD for near, 8.67 ± 5.42 PD for distance, and 4.54 ± 6.59 PD for near 5.19 ± 6.7 PD for distance, respectively; the difference was statistically significant (p = 0.042). The recovery time to orthophoria after hyperopic correction in patients associated with anisometropia was 2.20 ± 1.01 months, significantly longer than 1.47 ± 0.86 months in patients associated with isometropia (p = 0.017).

Conclusions

In refractive accommodative esotropia patients associated with anisometropia, the recovery time to orthophoria after hyperopic correction was significantly prolonged but there were no statistical differences in other clinical manifestations.

Keywords: Anisometropia, Isometropia, Refractive accommodative esotropia

References

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Table 1.

Clinical features of accommodative esotropia

	Anisometropia (n = 15)	Isometropia (n = 30)	p-value
Sex
Male	9	11	0.2047*
Female	6	19
Age at onset (mean ± SD, yr)	2.95 ± 1.59	3.03 ± 2.05	0.895^†
Age at initial visit (mean ± SD, yr)	5.80 ± 2.34	4.97 ± 2.53	0.291^†
Follow up period (mean ± SD, mon)	50.13 ± 31.03	51.10 ± 38.93	0.934^†
Age at the initiation of therapy (mean ± SD, yr)	6.03 ± 1.99	5.82 ± 2.19	0.749^†
Duration of misalignment (mean ± SD, yr)	3.08 ± 1.59	2.78 ± 2.01	0.621^†
Diopter of anisometropia (D)	2.04 ± 1.74	0.32 ± 0.63	0.001^†

Values are presented as mean ± SD.

Mean ± SD, yr = year ± standard deviation; Mean ± SD, mon = month ± standard deviation; D = diopter.

^* Fisher's exact test

^† Paired t-test.

Table 2.

Changes in hyperopia and annual decrease in anisometropia group

		Initial visit	Final visit	Annual change in hyperopia (Mean ± SD)	p-value*
Anisometropia (eye = 30)	High hyperopia level (eye = 15)	5.87 ± 1.60D	4.37 ± 2.30D	0.41 ± 0.29D	<0.01
	Low hyperopia level (eye = 15)	3.95 ± 2.31D	2.82 ± 2.43D	0.15 ± 0.47D	<0.01
	p-value^†			0.11

Values are presented as mean ± SD.

SD = standard deviation; D = diopter; High hyperopia level = Same patient, eye with high hyperopia; Low hyperopia level = Same patient, eye with low hyperopia.

^* The difference between the initial visit and the final visit

^† The difference of annual change in hyperopia between the high hyperopia level group and the low hyperopia level group.

Table 3.

Changes of esotropia deviation with and without hyperopic correction

			Anisometropia (n = 15)	Isometropia (n = 30)	p-value*
Initial visit	Angle of esotropia without correction	Near	25.00 ± 9.82	26.10 ± 11.05	0.746
	(mean ± SD, PD)	Far	24.13 ± 9.66	24.48 ± 10.29	0.914
1 month	Angle of esotropia with correction	Near	8.80 ± 5.63	4.54 ± 6.59	0.048
f/u visit	(mean ± SD, PD)	Far	8.67 ± 5.42	5.19 ± 6.78	0.042
Final visit	Angle of esotropia without correction	Near	16.00 ± 9.60	15.14 ± 11.09	0.802
	(mean ± SD, PD)	Far	15.14 ± 11.09	14.25 ± 11.14	0.708
	Angle of esotropia with correction	Near	3.60 ± 2.85	3.07 ± 5.37	0.189
	(mean ± SD, PD)	Far	3.30 ± 3.09	3.11 ± 5.93	0.243

PD = prism diopters; SD = standard deviation; f/u = follow up.

^* Paired t-test.

Table 4.

Recovery time period to orthophoria^† after hyperopic correction

	Anisometropia (n = 15)	Isometropia (n = 30)	p-value*
Recovery time period (mean ± SD, mon)	2.20 ± 1.01	1.47 ± 0.86	0.017

Mon = month; SD = standard deviation.

^* Wilcoxon signed ranks test

^† Orthophoria ≤ 8PD at near and far after hyperopic correction.

Table 5.

Amblyopia and sensory status (based on Titmus and W orth-4-Dot test)

		Anisometropia (n = 15)	Isometropia (n = 30)	p-value*
Ambylopia (%)	Initial visit	11 (73.3%)	17 (56.7%)	0.3414
	Final visit	4 (26.7%)	3 (10%)	0.1992
	p-value*	<0.001	<0.001	0.239
Stereopsis (arc/sec)	Final visit	183.57 ± 187.03	201.50 ± 226.22	0.717
Fusion at near and distance	Final visit	5/14 (35.7%)	15/20 (75%)	0.045

^* Chi square test.

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