Abstract
In partially accommodative esotropia (PAET), prism glasses can correct small angles of residual esotropia but the long-term effect of prismatic correction alone without surgery has not been reported. We aimed to investigate the long-term outcome of prism glasses after full hypermetropic correction for PAET. This retrospective, case-control study was performed for children aged 10 years or younger with a residual esotropia of ≤ 20 prism diopters (PD) after full hypermetropic correction who were fitted with prism glasses and followed-up for 3 years or more. Clinical characteristics and the angle of esodeviation were obtained at each follow-up examination. Successful motor outcome after 3 years of prismatic correction was determined if the residual angle of esotropia after full hypermetropic correction was ≤ 10PD. Patients who eventually weaned off prism glasses were noted. Among 124 patients, 30.6% achieved success and 7.3% weaned off prism glasses after 3 years of prism-wear. Smaller amount of latent esodeviation (P = 0.001) revealed by prism adaptation and good fusional response at near with the Worth 4-dot test were significant prognostic factors of success by multivariate analysis (P = 0.033). After 3 years of wearing prism glasses, the rate of improvement in stereoacuity was higher in the Success group (60.5% vs 27.9%) (P = 0.001), however, there was no significant difference between the prism-weaned group and prism-wearing group within the Success group (P>0.05). Prism glasses for small angle PAET can be a treatment option in patients who have a small angle of latent esodeviation revealed by prism adaptation and good sensory fusion at near. Otherwise, early surgery may be advisable as the majority of patients showed suboptimal outcome even after long-term prism-wear.
Highlights
Accommodative esotropia (PAET) is a form of accommodative esotropia characterized by residual esodeviation after full correction of hypermetropia.[1,2,3] The first-line treatment of Partially accommodative esotropia (PAET) is full correction of hypermetropic refractive errors, various therapies, including occlusion, prism, miotics, botulinum toxin injection or surgical intervention, are considered to treat the remnant deviation.[4,5,6]In patients with PAET, surgery is usually considered if fusion cannot be achieved after 6–8 weeks of hypermetropic correction or if the remnant deviation is greater than 10 prism diopters (PD) both at near and at distance with full correction of hypermetropia.[6]
This retrospective, case-control study was performed for children aged 10 years or younger with a residual esotropia of 20 prism diopters (PD) after full hypermetropic correction who were fitted with prism glasses and followed-up for 3 years or more
After 3 years of wearing prism glasses, the rate of improvement in stereoacuity was higher in the Success group (60.5% vs 27.9%) (P = 0.001), there was no significant difference between the prism-weaned group and prism-wearing group within the Success group (P>0.05)
Summary
Accommodative esotropia (PAET) is a form of accommodative esotropia characterized by residual esodeviation after full correction of hypermetropia.[1,2,3] The first-line treatment of PAET is full correction of hypermetropic refractive errors, various therapies, including occlusion, prism, miotics, botulinum toxin injection or surgical intervention, are considered to treat the remnant deviation.[4,5,6]. In patients with PAET, surgery is usually considered if fusion cannot be achieved after 6–8 weeks of hypermetropic correction or if the remnant deviation is greater than 10 prism diopters (PD) both at near and at distance with full correction of hypermetropia.[6] Occasionally, prisms have been used in the management of PAET. In consecutive esotropia after exotropia surgery, prismatic correction achieved a successful motor alignment with good stereoacuity.[15, 16]
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