The effect of reducing hyperopic correction in patients with accommodative esotropia

Purpose To report a 2-year follow-up of a previously reported study of the effects of not correcting the total hyperopic refractive error in patients with accommodative esotropia. Methods Consecutive patients with refractive accommodative esotropia were prescribed the maximal tolerable amount of spectacle undercorrection, up to -1.5 D, and were followed up for 2 years. One year after an initial undercorrection, the maximal tolerable undercorrection was reevaluated. We analyzed changes in visual acuity, angle of deviation, stereoacuity, and fusional ability during the follow-up period. Results A total of 39 patients were included, of whom 1 was lost to follow-up. During the 2-year follow-up period, none of the patients had deterioration in visual acuity (right eye: 95% CI, -0.01 to -0.02; left eye: 95% CI, -0.10 to -0.03 [Wilcoxon signed rank test]), angle of deviation (at distance: 95% CI, -4.00 to 0.00; at near: 95% CI, -4.00 to 0.50), stereoacuity (95% CI, -0.55 to -0.10), or fusional ability. Small changes in the angle of deviation (2^Δ-4 ^Δ) were noted in 3 undercorrected patients. Conclusions We demonstrated stable eye alignment and binocular function 2 years after undercorrecting a hyperopic refractive error in patients with accommodative esotropia.