Clinically significant changes in the spherical equivalent hyperopia in patients with refractive accommodative esotropia

Abstract

Aims: To determine the frequency and factors affecting clinically significant (≥1.0 diopters, D) changes in the spherical equivalent (SE) hyperopia in patients with refractive accommodative esotropia (RAET). Materials and Methods: The medical records of consecutive patients 3–12 years of age with RAET who had cycloplegic autorefraction initially and at follow-ups, initial hyperopia ≥2.0 diopters, and a minimum follow-up of 5 years were reviewed. A difference of ≥1.0D in SE hyperopia between the initial and follow-up/final visits was considered clinically significant. Results: This study included 161 patients (median age, 5 years). The mean follow-up period was 8.7 ± 2.4 years (range, 5.0–17.5 years). Overall, 88 patients (55%) had no clinically significant (<1.0D) change; 65 (40%), ≥1.0D decrease; and 8 (5%), ≥1.0D increase in SE hyperopia between the initial and final visits. Twenty-seven patients (17%) had ≥2.0D decrease and 11 (7%) ≥3.0D. There was no clinically significant change in SE hyperopia in 83% at age ≤7 years, and a ≥1.0D decrease in about 45% after age 12 years and in 3% after age 16 years. A ≥2.0D decrease was more common with initial hyperopia ≥4.0D than with <4.0D (P = 0.001). There was no significant difference between amblyopic and nonamblyopic eyes (P = 0.276). Conclusions: A clinically significant (≥1.0D) decrease in SE hyperopia occurred in 40% and ≥3.0D in 7% of the patients with RAET. Most patients did not have a clinically significant decrease up to age 7 years and after age 16 years. Patients with initial hyperopia ≥4.0D had a more decrease. Amblyopia had no effect.

Keywords

• cycloplegic refraction
• hyperopia
• refractive accommodative esotropia