Accomodative Esotropia- Surgery is indicated if eyeglasses don’t straighten eyes and will help improve alignment and increase possibility of binocular vision. Eyes will cross when uncorrected. Children can outgrow accodmodative esotropa in grade school and adolescent years as child becomes less far sighted. Difficult to predict.
If child has residual deviation only at near, prescribes bifocals. Unlike regular children kids with accommodation esotropia generally develop increasing amounts of hyperopia until age 7 and then it decreases. High AC/ A ratio
Development of a non accomodative esotropia increases chance of needing surgery to as much as 50%
Surgery consists of medial rectus muscal recessions based on esotropia. Some advocate using near angle measurement others suggest an average between near with and without correction, deriving from a high frequency of undercorrection post op with tradition approach based on distance.
Children with high AC/ A ratios even with bifocals may also require surgery. It requires the same medial rectus recession but with modification. Some advocate operation for the angle of deviation
High AC/A is one in which the near exceeds distance by more than 10 prism diopters. Dr Kushner dichotomizes his treatments based on on 2 different parameters. Uses different approach if optical correction achieves aliment at distance than if it doesn’t. Alignment defines as within 8 PD of straight. He also adjusts by age.
15 years after surgery, 19 of 22 patients had between 0 and less than 10 . Only 6 of 19 needed correction to maintain alignment though 8 used them for visual purposes. 2 needed bifocals for alignment at near. ALl showed some sensory fusion. 4 obtained sterosepsis 40 seconds and 8 obtained 60-200 seconds of sereosepsis
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