After evaluating children with esotropia, researchers in Philadelphia determined that hyperopia is stable or increases up to age seven, depending on baseline levels, but decreases gradually between ages seven and 15, regardless of baseline refractive error. While there were changes in refractive error over time in patients with accommodative esotropia, the researchers found that the decrease in refractive error is not sufficient to discontinue glasses for visual correction for the majority of children.

The retrospective study assessed 405 children with mean 7.6 cycloplegic refractions. The annual change in refractive error was -0.071D/year. Between ages three and seven, hyperopia among children with baseline hyperopia <4.0D increased by 0.12D/year, while hyperopia among those with baseline 4.0D or greater was stable. Hyperopia decreased from age seven to 15 in both subgroups: <4.0D subgroup -0.17D/year, ≥4.0D subgroup -0.18D/year.

Between the ages of seven to 12, parents might expect a decrease in hyperopia of only about 1.0D, so the change is typically not large enough to allow their children to discontinue spectacle use. The researchers also found that there was no significant difference in refractive change between fully and partial accommodative esotropia.

The researchers suggest that practitioners advise their pediatric patients and their parents on the likelihood of needing long-term refractive correction for the condition.

Bonafede L, Bender L, Shaffer J, et al. Refractive change in children with accommodative esotropia. Br J Ophthalmol. December 5, 2019. [Epub ahead of print].