Esotropia Outcomes and the Influence of Delay to Wearing Full Hypermetropic Correction

PURPOSE: To assess whether delay to full hypermetropic correction wear in children might influence the outcome of a diagnosis of full versus partially accommodative esotropia. 

METHODS: All children younger than 7 years who were referred with possible strabismus over a 1-year period were assessed. A standard set of details were documented: age at which esotropia was first noticed, age at which esotropia was confirmed by an orthoptist, age at which glasses were prescribed, and age at which full refractive error was constantly worn. When full-time hypermetropic correction was worn, the type of esotropia was determined. 

RESULTS: There were 430 children referred. Of these, 117 had a concomitant esotropia (62 males and 55 females). Esotropia was confirmed at 35.47 ± 16.67 months of age (range: 4 to 78 months). There were 51 children (43.6%) with full accommodative esotropia, 57 (48.7%) with partially accommodative esotropia, and 9 (7.7%) with nonaccommodative esotropia. Longer delays between the time at which esotropia was identified and the time at which glasses were prescribed were associated with a reduced likelihood of an outcome of full versus partially accommodative esotropia (odds ratio [OR] = 0.73, 95% confidence interval [CI] = 0.58 to 0.93). Delay to glasses wear for full and partially accommodative esotropia was 1.94 ± 6.4 and 6.24 ± 8.36 months, respectively. Higher average spherical correction scores were associated with a higher likelihood of being in the full accommodative esotropia group (OR = 1.35, 95% CI = 1.07 to 1.69). 

CONCLUSIONS: A child with recent onset concomitant esotropia is more likely to achieve full versus partially accommodative esotropia if the delay to full hypermetropic corrective glasses wear is minimized.