Monitoring of controlled 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 controlled accommodative esotropia examined at 3- to 6-month intervals were reviewed for age at first control, the occurrence of decompensation, initial refraction and subsequent changes, and the need for increased correction of hyperopia or the addition of bifocals. Results: Decompensation occurred in 11 patients, not associated with substantial refractive changes toward or away from emmetropia. No instance of decompensation occurred in the first 12 months of observation, and only 11.5% occurred within 2 years. Although 7 of these decompensated patients were among the 18 (28.6%) requiring supplemental non-operative treatment, their mean initial hyperopia and annual refractive change did not differ significantly from the 11 patients who did not decompensate. Eight (18.6%) of 43 patients who were first controlled earlier than age 48 months later decompensated; 3 (15.0%) of 20 patients with later onset reached this outcome. Conclusions: Monitoring controlled accommodative esotropia at intervals of 9 to 12 months is adequate for most patients, at least over the first 2 years, other than 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 at onset of accommodative esotropia earlier or later than 48 months did not influence rapidity of decompensation.