The Prevalence and Predictive Factors of Deterioration in Accommodative Esotropia

Kwan Soo Kim; Chul Young Choi; Hae Ran Chang

doi:10.3341/jkos.2008.49.12.1968

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Kim, Choi, and Chang: The Prevalence and Predictive Factors of Deterioration in Accommodative Esotropia

Original Article

J Korean Ophthalmol Soc 2008;49(12):1968-1973.

Published online: 7 September 2008

DOI: https://doi.org/10.3341/jkos.2008.49.12.1968

The Prevalence and Predictive Factors of Deterioration in Accommodative Esotropia

Kwan Soo Kim, M.D., Chul Young Choi, M.D., Hae Ran Chang, M.D.

Department of Ophthalmology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea

Address reprint requests to Hae Ran Chang, M.D. Department of Ophthalmology, Kangbuk Samsung Hopsital, Sungkyunkwan University School of Medicine #108 Pyung-dong, Jongro-gu, Seoul 110-746, Korea Tel: 82-2-2001-2250, Fax: 82-2-2001-2262, E-mail: hrch0523@hanmail.net

Received 16 September 2008 Accepted 28 May 2008

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

A number of patients with accommodative esotropia who were initially well controlled with their optical correction will deteriorate. This study aims to examine the cautious clinical features of patients with accommodative esotropia during follow-up period by obtaining the prevalence and the predictive factors of deterioration in accommodative esotropia.

Methods

The records of 89 patients with accommodative esotropia whose eyes were aligned with optical correction (including bifocals) to 8 prism diopters (PD) of esotropia or less were reviewed. All patients were followed for a period of at least 2 years. The patients whose alignment was increased to 10PD of esotropia or greater during the follow-up period were included into the deteriorated group. We obtained the rate of deterioration and compared the clinical features of the deteriorated and controlled group.

Results

The mean follow-up period was 64.1±29.3 months. Seven (7.8%) of 89 patients was deteriorated. The mean interval of deterioration after initial optical correction was 41.8±26.9 months. The stereopsis was significantly worse in the deteriorated group ( p=0.024). The frequency of high AC/A ratio was also significantly higher in the deteriorated group ( p=0.003).

Conclusions

This study indicates that accommodative esotropia with high AC/A ratio or worse sensory status has an increased likelihood of deterioration.

Keywords: Accommodative esotropia, Deterioration, Predictive factors, Prevalence

References

1. Dickey CF, Scott WE. The deterioration of accommodative esotropia: frequency, characteristics, and predictive factors. J Pediatr Ophthalmol Strabismus. 1988; 25:172–5.

2. Ludwig IH, Imberman SP, Thompson HW, Parks MM. Long-term study of accommodative esotropia. J AAPOS. 2005; 9:522–6.

3. Black BC. The influence of refractive error management on the natural history and treatment outcome of accommodative esotropia (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2006; 104:303–21.

4. Choi KS, Chang JH, Chang YH, Lee JB. Occurrence and risk factors of decompensation and additional treatment in refractive accommodative esotropia. J Korean Ophthalmol Soc. 2006; 47:121–6.

5. Raab EL. Etiologic factors in accommodative esodeviation. Trans Am Ophthalmol Soc. 1982; 80:657–94.

6. Ludwig IH, Parks MM, Getson PR, Kammerman LA. Rate of deterioration in accommodative esotropia correlated to the AC/A relationship. J Pediatr Ophthalmol Strabismus. 1988; 25:8–12.

7. Sohn HJ, Paik HJ. Clinical features of refractive accommodative esotropia according to the age of onset. J Korean Ophthalmol Soc. 2006; 47:941–6.

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9. Raab EL. Monitoring of controlled accommodative esotropia. Trans Am Ophthalmol Soc. 2001; 99:225–8.

10. Baker JD, Parks MM. Early-onset accommodative esotropia. Am J Ophthalmol. 1980; 90:11–8.

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Table 1.

Comparison of clinical features between controlled and deteriorated group

	Controlled group	Deteriorated group	P-value^‡
Age at onset (mo)	38.1±16.4	26.2±17.7	0.092
Age at initial visit (mo)	52.1±26.1	35.0±18.1	0.063
Duration of misalignment (mo)	10.6±11.6	9.8±6.7	0.660
Initial hyperopia (D∗)	4.60±1.56	5.02±2.33	0.410
Initial deviation (PD^†)	21.27±8.72	27.91±12.59	0.131
Controlled deviation (PD^†)	2.94±2.90	5.28±3.45	0.052
Stereopsis (seconds of arc)	149.87±132.79	306.67±262.80	0.024

^∗ D=diopters;

^† PD=prism diopters;

^‡ Mann-Whitney test.

Table 2.

Frequency between controlled and deteriorated group

	Controlled group	Deteriorated group	P-value∗
High AC/A ratio	7.3% (6/82)	42.9% (3/7)	0.003
Anisometropia	20.7% (17/82)	0.0% (0/7)	0.180
Amblyopia	42.7% (35/82)	71.4% (5/7)	0.236
Hyperdeviation	6.1% (5/82)	14.2% (1/7)	0.407
Oblique dysfunction	17.1% (14/82)	42.9% (3/7)	0.096

^∗ chi-square test.

Table 3.

Rate of deterioration relative to age of onset (based on 75 patients on whom age of onset was noted)

Age of onset (months)	No. of patients	Rate of deterioration (%)
0~12	11	3 (27.3)
13~24	10	0 (0.0)
25~36	27	2 (7.4)
37~48	10	0 (0.0)
49~60	11	1 (9.1)
>60	6	0 (0.0)

Table 4.

Rate of deterioration relative to the duration of misalignment (based on 75 patients on whom the delay to treatment was noted)

Duration of misalignment (months)	No. of patients	Rate of deterioration (%)
<6	29	1 (3.4)
6~12	19	3 (15.7)
13~24	11	2 (18.0)
25~36	11	0 (0.0)
36<	5	0 (0.0)

Table 5.

Rate of deterioration relative to initial refractive erro

Refractive error (D∗)	No. of patients	Rate of deterioration (%)
<+2.5	7	2 (28.6)
+2.5 ~ +4.0	27	0 (0.0)
>+4.0	55	5 (9.1)

^∗ D=diopters.

Table 6.

Rate of deterioration relative to initial deviation (based on 70 patients on whom initial deviation were available)

Initial deviation	No. of patients	Rate of deterioration (%)
0<PD∗≤10	5	1 (20.0)
10<PD≤20	33	0 (0.0)
20<PD≤30	23	3 (13.0)
30<PD≤40	4	0 (0.0)
PD>40	5	2 (40.0)

^∗ PD=prism diopters.

Table 7.

Rate of deterioration relative to oblique dysfunction

Oblique dysfunction	No. of patients	Rate of deterioration (%)
0	72	4 (5.6)
1~2	3	1 (33.3)
3	12	1 (8.3)
4	2	1 (50.0)

Table 8.

Rate of deterioration relative to sensory status (based on 86 patients on whom Titmus and Worth-4-dot test were available)

Fusional status	No. of patients (%)	Rate of deterioration (%)
No fusion	0 (0.0)	0 (0.0)
Peripheral fusion	64 (74.4)	7 (10.9)
W-4-D only^∗	1	1 (100.0)
3000~200 sec	25	4 (16.0)
140~80 sec	38	2 (5.3)
Central fusion	22 (25.6)	0 (0.0)

^∗ W-4-D only=a response of fusion to the Worth-4-dot only at near.

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