Predictive value of trial frames in the treatment of accommodative esotropia

Abstract

Purpose: To determine if correction of hyperopia with trial frames fitted in the initial office visit of a child with esotropia can be used to predict the response to spectacle correction when evaluating a child for nonaccommodative esotropia. Methods: Patients presenting with a new-onset esotropia underwent a cycloplegic refraction and were then fitted with trial frames containing their full cycloplegic correction. Their alignment was evaluated while wearing the trail frames. The patients returned for another assessment after wearing their glasses for 1 month. A comparison was then made between the predicted and actual reduction in their esotropia provided by the glasses. Patients who continued to have an esotropia of at least 10Δ were considered to have a nonaccommodative component to their strabismus. Results: Twenty-three patients 2 to 8 years of age completed the study. Trial frames were 71% (10/14) sensitive and 100% (9/9) specific for the presence of nonaccommodative esotropia. The positive-predictive value for nonaccommodative esotropia was 100% (10/10). The negative-predictive value for nonaccommodative esotropia was 69% (9/13). Conclusions: Trial frame analysis may be helpful in predicting which patients with acquired esotropia may require surgery. A positive trial frame test may allow the strabismus surgeon to appropriately counsel families regarding the eventual need for strabismus surgery.