Abstract
Distance–near disparity esotropias are a group of heterogenous usually acquired strabismus disorders, where the angle of misalignment at near exceeds that at distance by 10 prism diopters or more, where the accurate correction of refractive errors and ambylopia are important early objectives. These aetiologically diverse entities respond non-uniformally to strabismus surgery and bifocals. The management challenge is one of ‘shrinking’ the disparity so that the affected individuals can develop and comfortably maintain binocular single vision and/or optimal alignment. Surgical procedures have continued to evolve but none of the current operative procedures are superior for all patients. Subclassifying this strabismus and highlighting publication data from more homogenous clinical series may assist with the optimisation of future management and treatment outcomes.
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References
Donders FC . On the Anomalies of Accommodation and Refraction of the Eye. The New Sydenham Society: London, UK, 1864.
Vivian AJ, Lyons CJ, Burke J . Controversy in the management of convergence excess esotropia. Br J Ophthalmol 2002; 86: 923–929.
Costenbader FD . Clinical course and management of Esotropia. In: Allen JH, (ed). Strabismus Ophthalmic Symposium 11: CV Mosby-Year Book. CV Mosby: St Louis, MO, USA, 1958.
Berk AT, Kocak N, Ellidokuz H . Refractive outcomes in Refractive Accommodative Esotropia. J AAPOS 2004; 8: 384–388.
Arnoldi K, Shainberg M . High AC/A ET: bifocals? surgery? or nothing at all? Am J Orthop 2005; 55: 62–74.
Wygnanski-Jaffe T, Trotter J, Watts P, Kraft SP, Abdolell M . Preoperative prism adaptation in acquired esotropia with convergence excess. J AAPOS 2003; 7: 28–33.
Raab EL . Etiologic factors in Accommodative Esodeviation. Trans Am Ophthalmol Soc 1982; 80: 657–694.
Havertape SA, Cruz OA, Miyazaki EA . Comparison of methods for determining the AC/A ratio in accommodative esotropia. J Pediatr Ophthalmol Strab 1999; 36: 178–183.
von Noorden GK, Morris J, Edelman P . Efficacy of bifocals in the treatment of accommodative esotropia. Am J Ophthalmol 1978; 85: 830–834.
Sloan LL, Sears ML, Jablonski MD . Convergence–accommodation relationships. Arch Ophthalmol 1960; 63: 283–306.
Tait EJ . Accommodative convergence. Am J Ophthalmol 1951; 34: 1093–1107.
Arnoldi KA . Convergence excess characteristics and treatment. Am Orthop J 1999; 49: 37–413.
von Noorden GK, Jenkins RH . Accommodative amplitude in children wearing bifocals. In: Lennerstand G, (ed). Update on Strabismus & Pediatric Ophthalmology. CRC Press: London, UK, 1994 pp 201–204.
Fresina M, Schiavi C, Campos EC . Do bifocals reduce accommodative amplitude in convergence excess esotropia? Graefes Arch Clin Exp Ophthalmol 2010; 248: 1501–1515.
Black BB . The influence of refractive error management on the natural history and treatment outcome of accommodative esotropia. Trans Am Ophthalmol Soc 2006; 104: 303–321.
Garretty T . Convergence excess esotropia, a proposed new classification and the effect of monocular occlusion. J Pediatr Ophthalmol Strabismus 2010; 47: 308–312.
Kutschke PJ, Keech RV . Surgical outcome after prism adaptation for esotropia with a distance–near disparity. J AAPOS 2001; 5: 189–192.
Leitch RJ, Burke JP, Strachan IM . Convergence excess esotropia treated surgically with fadenoperation and medial rectus muscle recessions. Br J Ophthalmol 1990; 74: 278–279.
Pratt-Johnson JA, Tillson G . Sensory outcome with non-surgical management of esotropia with convergence excess (a high accommodative convergence/accommodation ratio). Can J Ophthalmol 1984; 19: 220–223.
Pratt-Johnson JA, Tillson G . The management of esotropia with high AC/A ratio (convergence excess). J Pediatr Ophthalmol Strabismus 1985; 22: 238–242.
Kushner BJ, Preslan MW, Morton GV . Treatment of partly accommodative esotropia with a high accommodative convergence–accommodation ratio. Arch Ophthalmol 1987; 105: 815–818.
O’Hara MA, Calhoun JH . Surgical correction of excess esotropia at near. J Pediatr Ophthalmol Strabismus 1990; 27: 120–123.
Lueder GT, Norman AA . Strabismus surgery for elimination of bifocals in accommodative esotropia. Am J Ophthalmol 2006; 142: 632–635.
Peterseim MMW, Buckley EG . Medial rectus fadenoperation for esotropia only at near fixation. J AAPOS 1997; 1: 129–133.
Kushner BJ . Partially accommodative esotropia; should you overcorrect and cut the plus? Arch Ophthalmol 1995; 113: 1530–1534.
Akar S, Gokyigit B, sayin N, Demirok A, Yilmaz OF . Medial rectus faden operations with or without recession for partially accommodative esotropia associated with a high acciommodative convergence to accommodation ratio. Br J Ophthalmol 2013; 97: 83–87.
Clark RA, Ariyasu R, Demer JL . Medial rectus pulley posterior fixation is as effective as scleral posterior fixation for acquired esotropia with a high AC/A ratio. Am J Ophthalmol 2004; 137: 1026–1033.
Mitchell L, Kowal L . Medial rectus pulley (posterior fixation) sutures in accommodative and partially accommodative esotropia with convergence excess. J AAPOS 2012; 16: 125–130.
Wabulembo G, Demer JL . Longterm outcome of medial rectus recession and pulley posterior fixation in esotropia with high AC/A ratios. Strabismus 2012; 20: 115–120.
Vivian A, Kousoulides L, Fells P, Lee JP . Posterior fixation sutures (faden operation) for the management of convergence excess esotropia. In: Lennerstrand G, (ed). Update on Strabismus and Paediatric Pphthalmology. CRC Press: Boca Raton, FL, USA, 1994 pp 395–398.
Rosenbaum AL, Santiago AP . Clinical Strabismus Management: Principles and Surgical Techniques. WB Saunders: Philadelphia, PA, USA, 1999.
Kushner BJ, Stolovich C . Fifteen year outcome of surgery for near angle in patients with accommodative esotropia and a high AC/A ratio. Arch Ophthalmol 2001; 119: 1150–1153.
Repka MX, Connett JE, Scott WE, Prism Adaptation Study Research Group. The one year surgical outcome after prism adaptation for the management of acquired esotropia. Ophthalmology 1996; 103: 992–998.
Prism Adaptation Study Research Group. Efficacy of prism adaptation in the surgical management of acquired esotropia. Arch Ophthalmol 1990; 108: 1248–1256.
Kutschke PJ, Keech RV . Surgical outcome after prism adaptation for esotropia with a distance–near disparity. J AAPOS 2001; 5: 189–192.
Parks MM . Abnormal accommodative convergence in squint. Arch Ophthalmol 1958; 59: 364–380.
von Noorden GK, Avilla CW . Nonaccommodative convergence excess. Am J Ophthalmol 1986; 101: 70–73.
Murray C, Newsham D . Survey of British and Irish orthoptists in the measurement of the AC/A ratio. Br Ir Orthopt J 2014; 11: 20–27.
Ehrenberg M, Nihalani BR, Melvin P, Cain CE, Hunter DG, Dagi LR . Goal-determined metrics to assess outcomes of esotropia surgery. J AAPOS 2014; 18: 211–216.
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This paper was presented at the 44th Cambridge Ophthalmological Symposium, ‘Ocular Motility’ 4th and 5th September 2014
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Burke, J. Distance–near disparity esotropia: can we shrink the gap?. Eye 29, 208–213 (2015). https://doi.org/10.1038/eye.2014.277
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DOI: https://doi.org/10.1038/eye.2014.277
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