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What is accommodative
esotropia?
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We have a very strong family history of farsightedness in the family. One
of my siblings developed a squint and had to wear glasses at the age of
three. My two sons are farsighted like me but they do not seem to have any
eye deviation and they do not complain of any blurring of vision. Can they
wear glasses to prevent developing a squint?
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Why is it necessary to treat the condition during the intermittent stage?
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What
are the treatment options for accommodative esotropia?
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When can accommodative esotropes start wearing glasses? Does it improve in
time? Do they ever get off glasses?
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Why are some children with esotropia on bifocals? Do they ever get off
bifocals?
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My child has just been prescribed with glasses for high hyperopia. However,
she doesn’t want to wear them. How do I get her to wear her spectacles?
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When can my child stop wearing his corrective glasses? Is weaning really
necessary? How is it done in accommodative esotropes?
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Is optical correction as equally effective as surgery in treating the
deviation in accommodative esotropia?
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My child has been on single vision lenses for accommodative esotropia for a
year now and she still manifests some inward deviation while wearing her
glasses. Will she benefit from surgery?
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Is refractive surgery
an option for children with accommodative esotropia?
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What is accommodative esotropia?
Accommodative esotropia is an inward deviation related to very high amount of
hyperopia or farsightedness. Parents or pediatrician would usually take note of
an intermittent deviation when the child is fatigued or ill. If the appropriate
optical correction is not given at this insipient stage, the deviation may
become constant. Amblyopia could set in once this happens. The sooner the
child is treated during the intermittent stage, the better the sensory outcome
is. A good sensory outcome implies good binocular vision or high-grade
stereopsis.
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We have a very strong family history of farsightedness in the family. One of my
siblings developed a squint and had to wear glasses at the age of three. My two
sons are farsighted like me but they do not seem to have any eye deviation and
they do not complain of any blurring of vision. Can they wear glasses to
prevent developing a squint?
Accommodative esotropia is a hereditary condition. Most accommodative esotropes
have a history of either farsightedness or squint among first or second degree
relatives. These kids exhibit significant hyperopia on refraction. Family
history and high hyperopia are considered as risk factors for developing
accommodative esotropia. Although farsightedness can be corrected with glasses,
these should not be given unless they can improve vision and unless there is a
history of intermittent or manifest inward deviation. Giving glasses on a
prophylactic basis is not recommended.
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Why is it necessary to treat the condition during the intermittent stage?
The aims of
prompt treatment of accommodative esotropia include: maintenance of normal
binocular visual acuity, restoration of ocular alignment, maintenance of
high-grade binocularity, and probably the most difficult, successful weaning
from optical correction.
The aims of
treatment are more or less achieved provided that optical correction is done at
a time that the deviation is still in the intermittent stage. Children with
risk factors should be followed up on a regular basis for a cycloplegic
refraction to unveil more hyperopia. Parents should inform the family’s
pediatric ophthalmologist once any deviation is noticed. A non-accommodative
component and amblyopia could set in if treatment is not initiated at the proper
time.
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What are
the treatment options for accommodative esotropia?
The usual
initial intervention done is optical correction. This could be in the form of
single vision lenses or contact lenses, depending on the age of the child and
the motivation of the child and the parents. Bifocals are given to those with
high accommodative convergence/accommodation ratio, who exhibit a much larger
inward deviation at near. Surgery is usually recommended for those with
residual deviation while wearing their full correction. The surgery is done to
correct the non-accommodative component. It should be explained to parents that
the child will still have to wear the full correction after surgery, in order to
correct the accommodative component of the condition.
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When can accommodative esotropes start wearing glasses? Does it improve in
time? Do they ever get off glasses?
The average
onset of accommodative esotropia is three years of age. However, it may occur
much earlier than this. The ideal time to wear glasses for young hyperopes like
them is when an intermittent inward eye deviation is noted. Most of the time,
the parents or the pediatrician notices this. Wearing the full correction will
control the eye deviation.
A regular
cycloplegic refraction is recommended because the degree of farsightedness may
actually increase by the age of six or seven. It then gradually decreases after
this age, so the child may be weaned off the glasses slowly. Children with
significantly high hyperopia, however, would most likely be on spectacles or
contact lenses until adulthood.
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Why are some children with esotropia on bifocals? Do they ever get off
bifocals?
Children
with accommodative esotropia are not a homogenous group of patients. The ones
who benefit from bifocals are those with high accommodative
convergence/accommodation ratio. This subset of patients exerts excessive
convergence when focusing on objects at near. The bifocals help straighten
their eyes by decreasing the degree of accommodation at near. The power of the
bifocal adds are gradually tapered after 7 years of age.
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My child has just been prescribed with glasses for high hyperopia. However, she
doesn’t want to wear them. How do I get her to wear her spectacles?
Topical
atropine may help in this situation. Atropine will relax accommodation and this
could encourage the child to wear the glasses. This is usually employed for the
first couple of months of wearing corrective glasses then discontinued.
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When can my child stop wearing his corrective glasses? Is weaning really
necessary? How is it done in accommodative esotropes?
Unlike
normal children, patients with accommodative esotropia exhibit an increase in
the amount of hyperopia or farsightedness up to 6 or 7 years of age. After this
age, the amount of hyperopia slowly decreases. This is the time that weaning
from corrective glasses is usually initiated. This is probably the most
challenging part of the treatment because the prescription for correction is
gradually decreased by small amounts every 6 months. Tapering of prescription
in a gradual fashion is recommended in order to prevent recurrence of the
deviation or any deterioration in vision. Children with low degree of hyperopia
could be free from glasses during their mid-teens. However, those with moderate
to high degrees of hyperopia tend to need to wear their correction until
adulthood.
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Is optical correction as equally effective as surgery in treating the deviation
in accommodative esotropia?
Optical
correction is usually the first line of treatment. Most cases are successfully
treated with glasses provided that the timing is correct. Giving the glasses
during the intermittent stage certainly saves a considerable number of patients
from having strabismus surgery for the eye deviation.
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My child has been on single vision lenses for accommodative esotropia for a year
now and she still manifests some inward deviation while wearing her glasses.
Will she benefit from surgery?
Sometimes,
a non-accommodative esotropia is superimposed on an accommodative type. This
usually happens when there was a delay in optical treatment. Surgery can be
done for this deviation. However, this does not mean that your child can be
free from glasses after the surgery. She will still need to wear her full
correction after the surgery in order to correct the accommodative esotropia due
to her high refractive error.
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Is refractive surgery an
option for children with accommodative esotropia?
Refractive
surgery in young children is still experimental at this stage.
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EYE REPUBLIC
Ophthalmology Atlas
CLINIC INFORMATION
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EYE REPUBLIC Ophthalmology Clinic
Manila
3/F Don Santiago Building Units 309-310
1344 Taft Avenue, Ermita
Manila, 1000 Philippines
Direct and Fax: (632) 536-2398
Trunk Line: (632) 523-8271 to 79 local 30
Mobile: (63917) 899-2020
Map and directions
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EYE REPUBLIC
Ophthalmology Clinic
Asian Hospital
and Medical Center
5/F Medical Office
Building (MOB) Suite 509
2205 Civic Drive,
Filinvest, Alabang
Muntinlupa City,
1781 Philippines
Direct:
(632) 771-9253
Direct and Fax:
(632) 771-9254
Mobile: (63917) 795-2020
Map and Directions
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EYE REPUBLIC Ophthalmology Clinic
Medical City
6/F Medical Arts Tower Inc (MATI) Suite 602
MERALCO Compound, Ortigas Avenue
Pasig City, 1604, Philippines
Direct and Fax: (632) 632-7846
Mobile: (63917) 537-2020
Map and directions
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EYE REPUBLIC
Ophthalmology Clinic
St. Luke's
Medical Center
6/F
Cathedral Heights Building Complex (CHBC)
North Tower Suite 614
279 E. Rodriguez
Sr. Boulevard
Quezon City, 1102
Philippines
Direct and Fax:
(632) 407-3883
Mobile: (63917) 855-2020
Map and directions
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All clinics are closed on Sundays and Holidays
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ACCOMMODATIVE ESOTROPIA information compiled by
Dr. Barbara L. Roque
and initially uploaded on July 24, 2005.
Last updated on
September 13, 2007. |
