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This study analysed clinical characteristics and surgical outcomes in patients with acquired comitant esotropia (ACET) and determined the prevalence of excessive mobile touch screen device use in these patients. This was a retrospective study of 35 patients of which three were excluded. They were reviewed over 13 years. Rising numbers were noted in more recent years. They analysed 27 patients who had surgery and a minimum of six months follow-up. There was no significant prior history. Twenty-one (78%) had history of intensive mobile use. Mean age at onset of diplopia was 17.8 ±10.3 years. Presenting age was 20.5 ±11 years and age at surgery was 21.5 ±11.1 years. Mean spherical equivalent refractive error was -1.90 ±2.5D and -1.90 ±2.4D for right and left eyes. Eighteen (67%) were myopic. All had best corrected visual acuity of 20/20. Diplopia initially started at distance fixation. Mean angle was 35.6 ±10.3PD at distance and 38 ±10.5PD at near fixation. A positive prism adaptation test was noted in 85% with increasing angle to 49.1 ±11.6PD and 52.2 ±10.6PD for distance and near fixation. Ocular motility examination was normal. The authors note the high frequency of excessive mobile use and discuss the shorter preferred reading distance of mobiles versus books with need for greater accommodation and the potential to trigger excessive convergence. In susceptible people with low fusional capacity, this may induce acquired esotropia. This observation warrants further research.

Acquired comitant esotropia in children and young adults: clinical characteristics, surgical outcomes and associations with presumed intensive near work with digital displays.
Yilmaz PT, Fatihoglu OU, Sener EC.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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