This is a retrospective review of medical records of 47 patients with refractive ocular accommodative esotropia who achieved emmetropisation and orthotropia without hyperopic glasses correction and were followed up for at least three years. The objective of the study is to determine the long-term changes in refractive error and ocular alignment in patients with accommodative esotropia (AET) who were able to discontinue wearing hyperopic glasses because of emmetropisation. All of the patients had been prescribed as weak as possible glasses for best corrected vision. The refractive error and ocular alignment were analysed after the cessation of hyperopic glasses used. The mean follow-up period was 5.7 (+/-3.21) years after successful weaning from hyperopic glasses. The means were equivalent: refractive error was -1.01 (+/- 1.53) diopters, and the mean esotropia (ET) was 1.0 (+/- 8.7) prism diopters at the final visit. It was found that 55.3% of all patients developed myopia and the mean myopic progression rate per year was -0.51% (+/- 0.23) diopters per year. 87.2% (41 patients) showed orthotropia; three of the patients (6.4%) developed ET and three (6.4%) developed exotropia (XT). The six patients who had ET or XT all showed myopia. Two of the three patients who developed ET underwent squint surgery. Both patients initially had a low degree of hyperopia and a high ratio of accommodative convergence to accommodation (AC/A). The initial hyperopia correlated with the SE refractive error at the final follow-up (p<0.001). The authors concluded that emmetropisation occurs early in patients with AET. It is necessary to note the development of myopia and the deterioration of ocular alignment. The limitations witnessed in this study are: (1) The retrospective nature of this study and being uncontrolled under trial. (2) All of the patients had been prescribed as weak as possible glasses to provide best corrective vision - they may have shown a different clinical course than patients with full hyperopic corrections would have. (3) All of the subjects were of Asian origin and the results may not be as generalisable to other racial groups. 

Changes in refractive error in patients with accommodative esotropia after being weaned from hyperopic correction.
Cho YA, Ryu WY.
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Jonathan Chan

Royal Hallamshire Hospital, Sheffield, UK.

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