Journal List > J Korean Ophthalmol Soc > v.52(2) > 1008977

TOOLS
Suh, Oh, and Lim: Predictive Factors of Successful Weaning From Glasses in Accommodative Esotropia Patients
Original Article

J Korean Ophthalmol Soc 2011;52(2):227-232.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.2.227

Predictive Factors of Successful Weaning From Glasses in Accommodative Esotropia Patients

Soh-Youn Suh, MD1, Min Jin Oh, MD2, Key Hwan Lim, MD, PhD1

1Department of Ophthalmology, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea

2Department of Ophthalmology, National Medical Center, Seoul, Korea

Address reprint requests to Key Hwan Lim, MD, PhD Department of Ophthalmology, Ewha Womans University Mokdong Hospital #911-1 Mokdong, Yangcheon-gu, Seoul 158-710, Korea Tel: 82-2-2650-5154, Fax: 82-2-2654-4334, E-mail: Limkh@ewha.ac.kr

Received 15 June 201016 September 2010       Accepted 13 December 2010

Copyright © 2011 Korean Ophthalmological Society

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 investigate the predictive factors of successfully weaning children from glasses with accommodative esotropia who were monitored with manifest refraction on followup visits.

Methods

A retrospective review of 48 patients with accommodative esotropia was performed. Weaning was accom-plished by monitoring patients with manifest refraction on followup visits. The patients were divided into 2 groups: patients who were weaned successfully from glasses and patients who still needed glasses at their final visit. A comparative analysis of the multiple clinical features between the 2 groups was performed.

Results

Among the 48 patients, 15 patients were weaned successfully from glasses. The age of onset was significantly different between the 2 groups, 39.6 ± 14.9 months in patients who were weaned successfully from glasses and 30.7 ±16.9 months in patients who still needed glasses. In particular, the patients with onset of accommodative esotropia after 3 years of age were more likely to be weaned from glasses at their final visit.

Conclusions

Monitoring with manifest refraction could be another method of weaning children from glasses with accommodative esotropia and the age of onset appears to be the useful predictor of successful weaning in children who can fi-nally be weaned from glasses.

Keywords: Accommodative esotropia, Manifest refraction, Predictive factor, Weaning

References

1. Mohney BG. Common forms of childhood esotropia. Ophthalmology. 2001; 108:805–9.
crossref
2. Von Noorden GK. Binocular vision and ocular motility. 6th edition.St. Louis: The C.V. Mosby Co;2002. p. 16.
3. Wright KW, Spiegel PH. Pediatric ophthalmology and strabismus. 2nd ed.Springer;2003. p. 13.
4. Rubin SE. Bringing the management of accommodative esotropia into sharp focus. Am J Ophthalmol. 2006; 141:914–5.
crossref
5. Repka MX, Wellish K, Wisnicki HJ, et al. Changes in the refractive error of 94 spectacle-treated patients with acquired accommodative esotropia. Binocul Vis. 1989; 4:5–21.
6. Mulvihill A, MacCann A, Flitcroft I, O'keefe M. Outcome in refractive accommodative esotropia. Br J Ophthalmol. 2000; 84:746–9.
crossref
7. Hutcheson KA, Ellish NJ, Lambert SR. Weaning children with accommodative esotropia out of spectacles: a pilot study. Br J Ophthalmol. 2003; 87:4–7.
crossref
8. Lambert SR, Lynn M, Sramek J, Hutcheson KA. Clinical features predictive of successfully weaning from spectacles those children with accommodative esotropia. J AAPOS. 2003; 7:7–13.
crossref
9. Lee TY, Kim MM. Clinical characteristics of accommodative esotropia with successful wearing out of glasses. J Korean Ophthalmol Soc. 2007; 48:1699–705.
crossref
10. Hiatt RL, Braswell R, Smith L, Patty JW. Refraction using mydriatic, cycloplegic, and manifest techniques. Am J Ophthalmol. 1973; 76:739–44.
crossref
11. Seong GJ, Choi O. Comparison of near retinoscopy, retinoscopy under cycloplegia and subjective refraction. J Korean Ophthalmol Soc. 1987; 28:143–9.
12. Moon NJ, Kim JC, Koo BS. The study on the necessity of cycloplegic refraction in school children. J Korean Ophthalmol Soc. 1988; 29:377–85.
13. Cho YA, Baek SW. Clinical assessment of accommodative esotropia. J Korean Ophthalmol Soc. 1988; 29:371–8.
14. Yang H, Chang YH, Lee JB. Clinical features of refractive accommodative esotropia and partially accommodative esotropia. J Korean Ophthalmol Soc. 2004; 45:626–30.
15. Somer D, Cinar FG, Duman S. The accommodative element in accommodative esotropia. Am J Ophthalmol. 2006; 141:819–26.
crossref
16. Raab EL. Hypermetropia in accommodative esodeviation. J Pediatr Ophthalmol Strabismus. 1984; 21:P64–8.
17. Berk AT, Koçak N, Ellidokuz H. Treatment outcomes in refractive accommodative esotropia. J AAPOS. 2004; 8:384–8.
crossref
18. Lim SJ, Lee SY, Lee YC. Change of refractive error in patients with refractive accommodative esotropia. J Korean Ophthalmol Soc. 2007; 48:822–7.

Figure 1.
Comparison of refractive error change between glasses maintained group and glasses discontinued group. The annual changes of the refractive error in 2 groups were not significantly different.
jkos-52-227f1.tif
Figure 2.
Kaplan-Meier plots of the probability of glasses maintenance in accommodative esotropia patients with its onset before and after 3 years of age. The patients who presented accommodative esotropia after 3 years of age were more likely to be weaned successfully from glasses.
jkos-52-227f2.tif
Table 1.
Clinical characteristics of 48 patients with accommodative esotropia
  Mean ± SD∗ Range
Age at first visit (mon) 50.2 ± 22.8 15-122
Age at onset (mon) 33.5 ± 16.6 0-80
Age glasses prescribed (mon) 45.2 ± 19.2 15-109
Initial distance esodeviation (PD†) 25.5 ± 12.0 10-55
Initial refractive error (D‡) 4.41 ± 1.37 1.50-8.25
Final refractive error (D‡) 2.93 ± 1.62 0.38-7.50
Followup period (mon) 74.6 ± 42.5 24-165

∗ SD = standard deviation;

† PD = prism diopters;

‡ D = diopters.

Table 2.
Demographics and clinical characteristics of 2 groups
  Glasses maintained Glasses discontinued p value∗
Gender (Male:Female) 17:16 3:12 0.059
Amblyopia, patients (%) 15 (45.5%) 8 (53.3%) 0.613
Age at first visit (mon,, mean ± SD) 47.8 ± 22.2 55.7 ± 23.9 0.136
Age at onset (mon,, mean ± SD) 30.7 ± 16.9 39.6 ± 14.9 0.043
Age glasses prescribed (mon,, mean ± SD) 44.2 ± 21.5 47.3 ± 13.2 0.142
Initial distance esodeviation (PD†, mean ± SD) 27.2 ± 12.7 21.9 ± 9.7 0.143
Initial refractive error (D‡, mean ± SD) 4.59 ± 1.48 4.01 ± 1.00 0.145
Final refractive error (D‡, mean ± SD) 3.37 ± 1.62 1.97 ± 1.15 0.002
Follow up period (mon, mean ± SD) 69.0 ± 45.5 86.9 ± 33.2 0.089

∗ Mann-Whitney U test;

† PD = prism diopters;

‡ D = diopters.

Table 3.
Percentage of patients according to clinical characteristics who successfully weaned from their glasses
Characteristics Number of patients Successfully weaned (%) p-value∗
Age at first visit (yr)      
  <4 26 19.2 0.066
  ≥4 22 45.5  
Age at onset (years)      
  <3 23 13.6 0.023
  ≥3 25 47.8  
Age glasses prescribed (yr)      
  <4 30 20 0.052
  ≥4 18 50  
Initial distance esodeviation (PD†)      
  <25 26 38.5 0.355
  ≥25 22 23.8  
Initial refractive error (D‡)      
  <4 19 36.8 0.538
  ≥4 29 27.6  

Fisher's exact test;

† PD = prism diopters;

‡ D = diopters.

TOOLS
Similar articles