Literature review of associations for refractive error, and correction, on development of amblyopia and accommodative esotropia
Reviewed by Lauren R Hepworth

The authors report a literature review to determine the available evidence for the association between hypermetropia, astigmatism, anisometropia and the influence of early glasses and the development of amblyopia or accommodative esotropia. Studies were included where children were first examined at ages of 6–24 months. Longitudinal studies were included where outcomes were assessed at ages of 3–9 years and inclusive of refractive data. The review search identified 5623 studies from which 40 were retrieved for full text review and 6 from reference citations (total 46 full texts). Of these, 16 met the inclusion criteria: 3 reporting hypermetropia associated with development of amblyopia, 2 of hypermetropia associated with development of accommodative esotropia, 1 each of astigmatism associated with development of amblyopia or accommodative esotropia, 1 of anisometropia associated with development of accommodative esotropia, and 4 and 5 studies respectively for glasses associated with development of amblyopia or accommodative esotropia. The odds ratio (OR) for development of amblyopia ranged for hypermetropia at 8–12 months, between 17.09 and 141.67. For hypermetropia increasing from 6 months to 4 years, OR was 9.46. For development of accommodative esotropia with hypermetropia at 9–12 months, OR was 16.13 and 22.51. For hypermetropia increasing from 0–12 months and 4 years, OR was 5.33 and 195. For astigmatism and amblyopia, and astigmatism and accommodative esotropia, OR was 9.23 and 1.42 respectively. For early glasses at age 6–24 months, OR for developing amblyopia ranged from 0.10 to 0.79, and for accommodative esotropia, OR ranged from 0.79 to 2. The authors conclude hypermetropia and astigmatism correlated with development of amblyopia and accommodative esotropia, but not anisometropia. Influence of early glasses appears moderate. They acknowledge the use of different definitions of amblyopia per study and therefore the potential for over or under estimation of calculations.

Evidence for hypermetropia, astigmatism and anisometropia associated with, and early glasses preventing, the development of amblyopia and accommodative esotropia. 
Steltman JS, Loudon SE, Simonsz HJ. 
STRABISMUS
2026;34(1):78–86.