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Kim and Paik: Long-Term Changes of Hyperopic Refractive Error in Refractive Accommodative Esotropia
Original Article

J Korean Ophthalmol Soc 2015;56(4):580-585.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.04.580

Long-Term Changes of Hyperopic Refractive Error in Refractive Accommodative Esotropia

Iris Naheah Kim, MD, Hae Jung Paik, MD, PhD

Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea

￭ Address reprint requests to Hae Jung Paik, MD, PhD Department of Ophthalmology, Gachon University Gil Medical Center, #21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 405-760, Korea Tel: 82-32-460-3364, Fax: 82-32-460-3368 E-mail: hjpaik@gilhospital.com

Received 24 May 20147 August 2014       Accepted 7 March 2015

Copyright © 2015 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.

초록

Purpose:

To analyze the long-term changes of hyperopic refractive error in patients with refractive accommodative esotropia.

Methods:

We retrospectively reviewed the medical records of 54 patients with accommodative esotropia who underwent at least 36 months of follow-up and had hyperopia more than +1.50 diopter (D). The patients were divided into groups according to the degree of hyperopia: +1.50~<+3.00 D, ≥+3.00~<+5.00 D, and ≥+5.00 D, the age of their first hyperopic glasses prescription: under two-years old, between two to four-years old and older than four years old, whether or not they had amblyopia, the degree of astigmatism: <0.75 D, ≥0.75-<1.25 D, and ≥1.25 D and divided into two groups according to the degree of stereopsis: ≤400 sec and >400 sec. The divided groups were than retrospectively reviewed if they influenced the refractive error at the third year of follow-up using Fisher’s exact test, paired t-test, Wilcoxon’s signed-ranks test, Mann-Whitney U test, Kruskal-Wallis H test, and ANOVA ( p < 0.05).

Results:

The mean follow-up period was 103.72 ± 41.82 months for refractive accommodative esotropia. Patients with a greater initial hyperopic refractive error showed a significant tendency towards emmetropization with a higher rate of hyperopic decrease ( p < 0.001), regardless of the hyperopic refractive error. Statistical differences were not observed in patients who started wearing glasses after four-years old, patients with amblyopia, patients with a large degree of astigmatism, and patients with poor stereoacuity.

Conclusions:

Long-term changes of hyperopic refractive error in accommodative esotropia showed a significant decrease when initial hyperopic refractive error was high. Wearing hyperopic glasses at an older age and visual functions such as amblyopia, large degree of astigmatism, and poor stereoacuity may influence emmetropization.

Keywords: Binocularity, Emmetropization, Hyperopia, Refractive accommodative esotropia

References

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Figure 1.
Spherical equivalent refractive error according to the time of follow-up. D = diopter.
jkos-56-580f1.tif
Table 1.
Clinical characteristics of children diagnosed with refractive accommodative esotropia
Factors Values
Total number of patients 54
Average age (months) 42.87 ± 25.13
Sex (M:F) 22:32
Length of follow-up (months) 103.72 ± 41.82
Initial mean SE (diopter) 4.98 ± 2.10
3rd year mean SE (diopter) 4.11 ± 2.37
Initial mean astigmatism (diopter) 0.55 ± 1.13
3rd year mean astigmatism (diopter) 1.23 ± 0.82
Age at which spectacles were prescribed (months) 41.28 ± 18.82
Initial angle deviation in PD (PD) 30.31 ± 14.46

Values are presented as mean ± SD unless otherwise indicated.

SE = spherical equivalent; PD = prism diopter.

Table 2.
Spherical equivalent difference according to initial degree of hyperopia
Degree of hyperopia (diopter) Initial SE (diopter) 1st year SE (diopter) 2nd year SE (diopter) 3rd year SE (diopter) Difference of 3rd year and initial SE p-value
+1.50~<+3.00 2.15 ± 0.50 2.25 ± 1.65 2.32 ± 1.76 2.02 ± 1.62 0.14 ± 1.42 <0.001
≥+3.00~<+5.00 4.03 ± 0.49 3.94 ± 1.22 3.38 ± 1.41 3.09 ± 1.47 0.94 ± 1.51 <0.001
≥+5.00 6.76 ± 1.55 6.27 ± 2.38 5.90 ± 2.35 5.68 ± 2.17 1.08 ± 1.54 <0.001
p-value - - - - <0.001  

Values are presented as mean ± SD.

SE = spherical equivalent.

Table 3.
Spherical equivalent difference according to age at which spectacles were prescribed
Age at which spectacles prescribed (years) s were Initial SE (diopter) 3rd year SE (diopter) Difference of 3rd year and initial SE p-value
<2 6.17 ± 1.93 4.45 ± 2.06 1.86 ± 1.76 0.007
≥2-<4 5.13 ± 2.28 4.50 ± 2.71 0.47 ± 1.33 0.009
≥4 4.21 ± 1.69 3.48 ± 2.02 0.86 ± 1.47 0.064
p-value - - 0.045  

Values are presented as mean ± SD.

SE = spherical equivalent.

Table 4.
Spherical equivalent difference according to astigmatism
Astigmatism (diopter) Initial SE (diopter) D 3rd year SE (diopter) Difference of 3rd year and initial SE l p-value
<0.75 4.86 ± 2.44 3.91 ± 2.05 0.97 ± 1.41 0.006
≥0.75-<1.25 5.16 ± 1.56 4.10 ± 2.27 0.98 ± 1.66 0.011
≥1.25 4.84 ± 2.56 4.43 ± 3.13 0.51 ± 1.48 0.254
p-value - - 0.654  

Values are presented as mean ± SD.

SE = spherical equivalent.

Table 5.
Spherical equivalent difference according to amblyopia
Degree of amblyopia (line difference) Initial SE (diopter) 3rd year SE (diopter) Difference of 3rd year and initial SE p-value
0 5.50 ± 2.20 4.46 ± 2.53 1.03 ± 1.56 <0.001
2 4.18 ± 2.33 3.64 ± 2.54 0.54 ± 0.87 0.116
3 4.45 ± 1.44 3.36 ± 1.54 1.09 ± 1.77 0.173
≥4 3.85 ± 0.99 3.66 ± 2.10 0.19 ± 1.80 0.753
p-value - - 0.669  

Values are presented as mean ± SD.

SE = spherical equivalent.

Table 6.
Spherical equivalent difference according to stereoacuity
Stereoacuity (sec of arc) Initial SE (diopter) 3rd year SE (diopter) Difference of 3rd year and initial SE p-value
≤400 4.89 ± 2.08 3.62 ± 2.38 1.08 ± 1.38 <0.001
>400 4.96 ± 2.19 4.62 ± 2.34 0.46 ± 1.48 0.163
p-value - - 0.004  

Values are presented as mean ± SD.

SE = spherical equivalent.

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