Clinical Outcomes of Refractive Accommodative Esotropia in Korean Adolescent Patients

Tai Kyung Kim; Nam Yeo Kang

doi:10.3341/jkos.2010.51.12.1630

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Kim and Kang: Clinical Outcomes of Refractive Accommodative Esotropia in Korean Adolescent Patients

Original Article

J Korean Ophthalmol Soc 2010;51(12):1630-1638.

Published online: 7 September 2010

DOI: https://doi.org/10.3341/jkos.2010.51.12.1630

Clinical Outcomes of Refractive Accommodative Esotropia in Korean Adolescent Patients

Tai Kyung Kim, MD¹, Nam Yeo Kang, MD^1,²

¹Department of Ophthalmology and Visual Science, The Catholic University of Korea School of Medicine, Seoul, Korea

²Department of Ophthalmology, Bucheon St. Mary's Hospital, Bucheon, Korea

Address reprint requests to Nam Yeo Kang, MD Department of Ophthalmology, Bucheon St. Mary's Hospital, The Catholic University of Korea #2 Sosa-dong, Wonmi-gu, Bucheon 420-717, Korea Tel: 82-32-340-2125, Fax: 82-32-340-2661, E-mail: nyeokang@hanmail.net

Received 25 February 2010 Accepted 3 November 2010

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 report the clinical course of refractive accommodative esotropia (AE) and to determine whether the strabismus resolves during the adolescent years in Korean patients.

Methods

A total of 32 adolescent patients with AE associated with hyperopia were retrospectively reviewed. Ocular alignments, amblyopia, stereopsis, changes in refractive error with time after glasses prescribed, and clinical characteristics were studied.

Results

The mean age and follow-up were 14.9 and 10.1 years, respectively at the final visit. The Initial and final refractive errors were 5.16 and 2.52 diopters (D), respectively. Spectacles were initiated at a mean age of 4.7 years, and intentional undercorrection initiated from a mean age of 6.3 years. Hyperopic reduction after prescribing glasses followed the formula: Diopter (D) = 5.23 − 0.02 (Time) − 0.03 (Time)**². Initially, 16 out of 32 patients (50%) showed fully corrected hyperopia, and eventually, 71.9% wore partially corrected spectacles. The mean change of hyperopia per year was 0.26 D. Six out of 32 patients (18.8%) were successfully discontinued from hyperopic spectacles and the mean age of weaning was 14.7 years. Intentional initial undercorrection did not affect hyperopic reduction (p = 0.123).

Conclusions

AE persists through adolescence for a majority of Korean patients. These patients need to be carefully monitored during follow-up periods because most do not outgrow their hyperopia and need to using spectacles.

Keywords: Adolescent, Hyperopic reduction, Refractive accommodative esotropia, Weaning

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Figure 1.

Types of deviation at final visit at distance fixation.

Figure 2.

Range of refractive errors. SE means spherical equivalents.

Figure 3.

(A) Hyperopic reduction according to the time after glasses prescribed. (B) Hyperopic reduction according to age.

Figure 4.

Change in hyperopia before and after age 7 years.

Figure 5.

Changes of hyperopia from the initial visit to the final visit vs the initial hyperopia.

Figure 6.

Decrease of hyperopia in glasses and weaned group.

Table 1.

Amount of initial esodeviation before correction

Angle of deviation (PD)	Number of patients
Angle of deviation (PD)	Distance	Near
<20	8 (25.0%)	5 (15.6%)
20 ≤∼< 40	19 (59.4%)	22 (68.8%)
40 ≤	5 (15.6%)	5 (15.6%)

Table 2.

Comparison of clinical features of initial full correction group and partial correction group

	Full correction (n = 16)	Partial correction (n = 16)	p Value^*
Stereopsis (≤ 100) (%)	18.8	50.0	0.039
Fusion at near (%)	56.2	50.0	0.961
Fusion at distance (%)	62.5	43.8	0.376
Final refraction (D)	1.75 ± 2.21	3.3 ± 2.46	0.080
Hyperopic reduction (D)	3.37 ± 2.05	1.92 ± 1.79	0.049
Hyperopic reduction rate (D/yr)	0.33 ± 0.18	0.21 ± 0.24	0.123

^* Mann Whitney U-test.

Table 3.

Comparison of clinical features of spectacle dependant group and weaned group

	Glasses group	Weaned group
	(n = 26)	(n = 6)
Age of onset (yr)	3.66 ± 1.38	4.67 ± 1.70
Age at first glasses (yr)	4.50 ± 1.45	5.00 ± 1.50
Initial SE refraction (D)	5.26 ± 2.20	4.7 ± 1.40
Final SE refraction (D)	3.05 ± 2.45	1.25 ± 1.62
Amount of reduction (D)	2.35 ± 2.10	3.63 ± 2.30
Annual reduction rate of hyperopia (D/yr)	0.24 ± 0.20	0.34 ± 0.18
Duration of glasses (yr)	9.78 ± 2.65	11.7 ± 5.20
Initial near deviation (PD)	30.36 ± 10.5	22.0 ± 8.40
Initial distant deviation (PD)	27.08 ± 11.5	21.0 ± 8.90
Incidence of amblyopia (bilateral) (%)	57.6 (11.5)	66.7 (16.6)
Stereopsis (≤ 100) (%)	28.0	33.3
Fusion at near (%)	56.0	66.7
Fusion at distance (%)	52.0	66.7

Table 4.

Clinical features of patients successfully weaned from spectacle

Patient No./Sex	Age of first glasses (yr)	Initial ET^*(D/N)^†(PD)	Final ET^*(D/N)^†(PD)	Initial refraction^‡ OD/OS (D)	Final refraction^‡ OD/OS (D)	Age^§ discontinuation (yr)
1/F	5.0	20/25	0/2	+5.00–2.00×180	+0.25–2.00×180	11
				+5.00–1.00×180	+1.50–1.00×180	
2/M	4.5	30/30	2/8	+4.25–0.75×180	+1.50–0.50×180	12
				+5.25–1.00×180	+4.50–1.00×180	
3/F	7.0	10/10	6/6	+3.50–0.50×180	+1.75–0.75×180	17
				+6.50–0.50×180	+2.50–0.50×180	
4/M	3.5	30/30	0/0	+6.00–1.00×180	−1.00–0.75×180	18
				+4.00	−0.75	
5/F	3.5	20/20	6/6	+7.00	+2.00	16
				+7.00	+3.75	
6/F	6.5	15/20	0/0	+5.75–2.00×15	+4.25–2.00×20	14
				+3.25–0.50×170	+2.25–0.50×170	

PD=prism diopter; D=diopter; OD=oculus dexter; OS=oculus sinister.

^* ET esodeviation: deviation without correction

^† (D/N) distant/near deviation

^‡ cycloplegic refraction

^§ Age at discontinuing spectacle use.

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