Journal List > J Korean Ophthalmol Soc > v.55(2) > 1009888

J Korean Ophthalmol Soc. 2014 Feb;55(2):267-270. Korean.
Published online February 17, 2014.
Copyright © 2014 The Korean Ophthalmological Society
The Ratio of Accommodative-Convergence to Accommodation in Patients with Nonrefractive Accommodative Esotropia
Rebecca Kim, MD and Se Youp Lee, MD, PhD
Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea.

Address reprint requests to Se Youp Lee, MD, PhD. Department of Ophthalmology, Keimyung University Dongsan Medical Center, #56 Dalseong-ro, Jung-gu, Daegu 700-712, Korea. Tel: 82-53-250-8400, Fax: 82-53-250-7705, Email:
Received March 29, 2013; Revised June 25, 2013; Accepted December 20, 2013.



To measure the ratio of accommodative-convergence to accommodation (AC/A ratio) in patients with nonrefractive accommodative esotropia in comparison to refractive accommodative esotropia and normal groups.


A total of 43 subjects were divided into 3 groups: the nonrefractive accommodative esotropia group (group 1), the refractive accommodative esotropia group (group 2) and the normal group (group 3). Age, sex, age of onset, and refractive errors were recorded. The deviation angle was measured near and at distance by using a prism cover test. The AC/A ratio was calculated using a gradient method.


Refractive errors were 2.3 ± 1.7 D (OD) and 2.4 ± 2.1 D (OS) in group 1, 4.8 ± 0.9 D (OD) and 4.6 ± 1.1 D (OS) in group 2, and -0.3 ± 1.5 D (OD) and -0.5 ± 1.5 D (OS) in group 3. Group 2 had higher mean refractive errors than groups 1 and 3, while the difference in refractive error between group 1 and group 3 was not statistically significant. The AC/A ratio was 5.5 in group 1, 2.1 in group 2 and 2.2 in group 3; there was no significant difference between groups 2 and 3, while group 1 had a significantly higher AC/A ratio than both of these groups.


AC/A ratio in patients with nonrefractive accommodative esotropia is higher than that of refractive accommodative esotropia or normal children. It could be used for bifocal lens as non-surgical treatment.

Keywords: Nonrefractive accommodative esotropia; Ratio of accommodative-convergence to accommodation; Refractive accommodative esotropia


Table 1
Subject and subgroup demographics
Click for larger image

Table 2
Comparison of refraction error and AC/A ratio in each group
Click for larger image

Table 3
Comparison of esodeviation angle in group 1 and group 2
Click for larger image


This study was presented as a narration at the 108th Annual Meeting of the Korean Ophthalmological Society 2012.

1. von Noorden GK. In: Binocular Vision and Ocular Motility. 5th ed. St. Louis: Mosby; 1996. pp. 299-300.
2. Rutstein RP. Update on accommodative esotropia. Optometry 2008;79:422–431.
3. Rutstein RP, Daum KM. In: Anomalies of binocular vision : diagnosis & management. 1st ed. St. Louis: Mosby; 1998. pp. 260-261.
4. Kim WK, Kang SY, Rhiu S, et al. The analysis of AC/A ratio in nonrefractive accommodative esotropia treated with bifocal glasses. Korean J Ophthalmol 2012;26:39–44.
5. 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;104:303–321.
6. Wabulembo G, Demer JL. Long-term outcome of medial rectus recession and pulley posterior fixation in esotropia with high AC/A ratio. Strabismus 2012;20:115–120.
7. Arnoldi K, Shainberg M. High AC/A ET: Bifocals? Surgery? Or Nothing at All? Am Orthopt J 2005;55:62–75.
8. Fresina M, Schiavi C, Campos EC. Do bifocals reduce accommodative amplitude in convergence excess esotropia? Graefes Arch Clin Exp Ophthalmol 2010;248:1501–1505.
9. Fry GA, Haines HF. Tait's analysis of the accommodative-convergence relationship. Am J Optom 1940;17:393–397.
10. Raab EL. Accommodative esotropia: a reassement. Am Orthopt J 1985;35:6–11.
11. Parks MM. Abnormal accommodative convergence in squint. AMA Arch Ophthalmol 1958;59:364–380.
12. Lee DC, Park JH, Lee YC, Lee SY. A ratio of accommodative-convergence to accommodation in patients with refractive accommodative esotropia. J Korean Ophthalmol Soc 2010;51:988–991.