Risk factors for abnormal binocular vision after successful alignment of accommodative esotropia

Purpose: The purpose of this study was to identify clinical factors associated with abnormal binocular vision outcomes among children with accommodative esotropia (ET) whose eyes were successfully realigned with spectacles only or with spectacles and surgery. Methods. The participants were 69 children with accommodative ET who were followed up prospectively from the time of diagnosis. Clinical factors examined in this study included, high accommodative convergence-to-accommodation (AC/A) relationship, high hyperopia, anisometropia, age of onset, and duration of eye misalignment. Binocular vision was assessed using measures of stereopsis, fusional vergence, sensory foveal fusion, and motion visual-evoked potential (mVEP). Results. Children with a high AC/A relationship are 2.2 times more likely to have an absence of fusional vergence than are children with a normal AC/A relationship. Children having a duration of constant eye misalignment greater than or equal to 4 months before being successfully treated are 4.6 times more likely to have abnormal stereopsis, 33 times more likely to have no stereopsis, 37 times more likely to have an absence of fusional vergence, 31 times more likely to have an absence of sensory foveal fusion, and 17 times more likely to have an asymmetric mVEP response than children with a duration of constant ET diagnosed at 0 to 3. months. Conclusions: Following successful eye alignment, as many as 75% of patients with accommodative ET had anomalous binocular vision. A high AC/A relationship poses a significant risk for abnormal fusional vergence only. A constant eye misalignment lasting greater than or equal to 4 months poses a significant risk for anomalous binocular vision on all measures studied.