Factors influencing stereoacuity in accommodative esotropia

Purpose: Despite successful optical realignment, many children with accommodative esotropia (ET) have abnormal stereoacuity. In a prospective study, we examined the influence of age of onset, age at alignment, duration of constant misalignment, and accommodative convergence/accommodation ratio on random dot stereoacuity outcomes in accommodative ET Methods: Participants were 111 consecutive children with accommodative ET. Random dot stereoacuity was measured using the Randot preschool stereoacuity test, the Randot stereoacuity test, the infant random dot stereoacuity cards, and the Lang 1. Results: Age of onset has only a minor influence on stereoacuity (P < .02); children with onset greater than or equal to age 25 months have better stereoacuity compared with children with an onset between ages 7 and 17 months. Age at alignment has a minor influence on stereoacuity (P < .001); children with intermittent ET who have been treated have better stereoacuity than children with a constant ET aligned between ages 6 and 24 months and after age 24 months. Duration of constant misalignment has the strongest influence on stereoacuity (P < .001); children who had intermittent misalignment or who had a constant misalignment of less than 4 months' duration have better stereoacuity than patients who had a constant misalignment greater than 4 months' duration. The accommodative convergence/accommodation ratio does not influence stereoacuity outcomes (P > .10). Conclusions: Fine random dot stereoacuity is associated with a constant misalignment of less than 4 months' duration. These findings promote prompt and aggressive treatment of accommodative ET at the onset of intermittent or constant misalignment.