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Refractive change in children with accommodative esotropia
  1. Lucas Bonafede1,
  2. Lloyd Bender1,
  3. James Shaffer2,
  4. Gui-shuang Ying2,
  5. Gil Binenbaum1
  1. 1Department of Ophthalmology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  2. 2Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Gil Binenbaum, Department of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; binenbaum{at}


Objective To determine whether there is a measurable change in hyperopia in children with accommodative esotropia over time.

Methods and analysis A retrospective cohort of children with fully or partially accommodative esotropia diagnosed by age 7 years, followed to age 10 or older, and with at least two cycloplegic refractions, one before age 7 years and one after age 10 years. The annual change was calculated from linear mixed-effect models, overall and during two age periods with subgroup analysis by baseline refractive error (<4D, ≥4D) and type (partial, full) of accommodative esotropia.

Results 405 subjects were studied. Mean age at first and last visit was 3.2 and 12.1 years, respectively, with mean 7.6 cycloplegic refractions. The annual change (95% CI) in refractive error was −0.071 (−0.087 to –0.055) D/yr. Between ages 3 and 7, hyperopia among children with baseline hyperopia <4D increased by 0.12 (0.08 to 0.16) D/yr, while hyperopia among those with baseline 4D or greater was stable (0.0D/yr, −0.03 to 0.04) (p<0.001). Hyperopia decreased from age 7 to 15 years in both subgroups: <4D subgroup −0.17 (−0.20 to –0.14) D/yr, ≥4D subgroup −0.18 (−0.21 to –0.15) D/yr (p=0.58). There was no significant difference in refractive change between fully (n=274) and partially (n=131) accommodative esotropia (p≥0.10).

Conclusion Hyperopia in children with accommodative esotropia is stable or increases up to age 7 years, depending on baseline hyperopia, but decreases gradually between ages 7 and 15 years regardless of baseline refractive error.

  • child health (paediatrics)

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  • Presented in part at the 2015 Annual Meeting of the American Association of Pediatric Ophthalmology and Strabismus. Denver/Colorado/May 2015.

  • Contributors LBo: planning, conducting, reporting. LBe: planning, reporting. JS: planning, conducting, reporting. GY: planning, conducting, reporting. GB: planning, conducting, reporting.

  • Funding Supported by National Institutes of Health grants P30 EY01583-26, 5T35DK060441-10, and UL1RR02499, and the Richard Shafritz Endowed Chair in Ophthalmology Research.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the Institutional Review Board of The Children’s Hospital of Philadelphia, conformed to the requirements of the United States Health Insurance Portability and Privacy Act, and adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.