Long-term changes in the cylinder power of hypermetropic children with and without accommodative esotropia

Abstract

Introduction: Lambert and Lynn suggested that cylinder power increases in children with accommodative esotropia treated with spectacles. We analyzed the changes in cylinder power of spectacle-wearing hypermetropic children with and without esotropia. Methods: Refractive errors were followed in 108 children with hypermetropia with and without esotropia for a mean of 3.9 years. Cycloplegic refractions were performed by retinoscopy. The refractive data were analyzed for the entire group and according to age of spectacle prescription, and ocular alignment. Results: The mean cylinder power increased on average by 0.16 D. In the youngest age group (0 < 2 years) the mean increase was 0.3 D; in the second group (2 < 4 years) the mean increase was 0.2 D, and in the third group (>4 years) the mean increase was 0.08 D. There was a tendency toward a larger average increase in astigmatism in the accommodative esotropes. Discussion: Similar to the results reported by others, we found a slight increase in cylinder power, which was more substantial among patients under the age of two. Nevertheless, this change, although statistically significant, is probably of no clinical importance. Conclusions: In children wearing spectacles for hypermetropia with and without esotropia, astigmatism increases minimally. Cylinder power changes were more common in the accommodative esotrope group.