Follow-up monitoring of accommodative esotropia

Purpose: To ascertain an examination interval that will not increase the risk of untimely detection of decompensation of accommodative esotropia whether or not initial nonoperative treatment must be supplemented. Methods: The records of 63 patients with accommodative esotropia examined at 3-to 6-month intervals were reviewed for the occurrence of decompensation, changes in refraction, and the need for increased correction of hyperopia or the addition of bifocals. Results: Decompensation, which was not associated with substantial refractive changes toward or away from emmetropia, occurred in 11 patients. No instance of decompensation occurred in the first 12 months of observation. Although 7 of these decompensated patients were among the 18 (28.6%) requiring supplemental nonoperative treatment, their mean annual refractive change did not differ significantly from the 11 patients who did not decompensate. Eight (18.6%) of 43 patients first controlled earlier than age 48 months later decompensated; 3 (15.0%) of 20 patients with later onset reached this outcome. Conclusions: The monitoring of controlled accommodative esotropia at intervals of 9 to 12 months is adequate for most patients, at least over the first 2 years, with the exception of those requiring treatment for associated conditions such as amblyopia. Refractive error changes and the need for supplemental treatment after initial control are not prominently associated with decompensation. Age of onset of accommodative esotropia earlier or later than 48 months did not influence rapidity of decompensation.