Is the maximum hypermetropic correction necessary in children with fully accommodative esotropia?

Caroline J MacEwen ^1*, Elspeth G Lymburn ² and Whye Onn HO ³

¹ Ninewells Hospital, United Kingdom
² NHS Fife, United Kingdom
³ Ninewells Hospital, Dundee, United Kingdom

^* To whom correspondence should be addressed. E-mail: c.j.macewen{at}dundee.ac.uk.

Accepted 5 March 2008

Abstract

This prospective study explores the effect of reduction in hypermetropic refractive correction on the angle and control of fully accommodative esotropia.

Methods 30 childhood cases with fully accommodative esotropia were recruited. The angle of deviation with and without full hypermetropic correction (near and distance) was measured. The overall effect of reduction of the correction by one and two spherical dioptres (DS) on the angle and control of the deviation was identified.

Results With the full hypermetropic correction in place the angle of deviation for near was less than 10 prism dioptres (pd) in 73% of the participants and the distance deviation was less than 10pd in 93%. When the prescription was reduced by 1.00DS the percentage of those with a near deviation of less than 10pd fell to 30% and 57% for the distance. Twenty percent immediately decompensated to manifest esotropia with reduction of 1 dioptre of spectacle correction.

Conclusion Children with fully accommodative esotropia who are given the full hypermetropic correction demonstrate smaller, more controllable angles of deviation than those who are undercorrected by as little as only one dioptre. This supports the practice of providing the maximum hypermetropic correction for childhood esotropes.