Abstract
To the Editor. —We read with interest the article by Kushner et al1in the November 1989 issue of theArchives. The authors found a significant inverse correlation between axial length and response to surgery in patients with esotropia. They implied that the axial length variation was thecauseof a portion of the variability found with strabismus surgery. They suggest that a surgical formula designed to take axial length into account would decrease that variability. We question these conclusions based on the following concerns. Most importantly, the population of esotropia patients on which this study was based is heterogeneous. It can be divided into two quite different groups, those with congenital esotropia and those with acquired esotropia (including decompensated accommodative esotropia). These two groups of patients differ in age of onset of strabismus and in average quantity of esotropia. Patients with congenital esotropia are usually operated on between
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