Management of high AC/A esotropia
Reviewed by Fiona Rowe

The purpose of this study was to determine the long-term effect of treating high accommodative convergence to accommodation (AC/A) esotropia with single vision lenses (SVL) compared with the effectiveness of using SVL on patients with basic refractive esotropia and a normal AC/A ratio. The authors identified 23 patients with high AC/A esotropia and 14 patients with refractive esotropia. Patients with high AC/A ratio showed high improvement and low deterioration rates, suggesting SVL is an effective form of treatment for high AC/A esotropia. Average hypermetropia was significantly higher in patients with refractive esotropia than AC/A esotropia. No patients were weaned out of glasses during the study. Each group had a significant decrease in size of deviation at near fixation after five years of treatment with SVL. Control of deviation at near fixation improved in both groups over the follow-up period but this was significantly better in the refractive group than the AC/A group. The AC/A group had significantly increased stereopsis but there was better stereopsis in the refractive group at five years follow-up. The authors found that using SVL to treat high AC/A esotropia did not have a negative impact on the 
development of stereopsis and propose SVL as an acceptable form of treatment.

Single-vision lenses: a comparison of management of high AC/A esotropia and refractive esotropia.
Gerling A, Arnoldi K.
STRABISMUS
2013;21:106-9.