Undercorrection may cause no side effects in refractive accommodative esotropia

Am J Ophthalmol. 2011;151(3):535-541.

Prescribing undercorrected spectacles to patients with refractive accommodative esotropia does not deteriorate vision, a study said.

"Two factors, baseline [spherical equivalent] refractive error and age of onset, had the strongest association with the maximal tolerable amount of under-correction," the study authors said.

The prospective interventional case series included 31 patients with refractive accommodative esotropia who underwent the maximal tolerable amount of undercorrection and seven patients who underwent 1.5 D of undercorrection. Mean patient age was 6.9 years, and mean age of onset noted by parents was 28.8 months.

After a mean 0.89 D of undercorrection, no patient showed deterioration in visual acuity, stereoacuity or fusional ability during the 6-month follow-up period.

"The maximal tolerable amount of under-correction in our patients was much smaller than expected. Only 1 D of under-correction based on cycloplegic refraction increased the angle of deviation in more than half the patients," the authors said.

Two patients experienced a slight increase of 2 ΔD in the angle of deviation, and a small number of patients had mild asthenopia that disappeared within a few days.

Researchers determined that the maximal tolerable amount of undercorrection correlated with mean spherical equivalent refractive error of both eyes (P = .012) and age of onset (P = .006).