Cycloplegic refractions in children who never wore and who always wore prescribed spectacles for refractive accommodative esotropia: exploring the natural history of this form of strabismus and the effect of treatment on their hyperopia.

Purpose: To compare cycloplegic refractions in accommodative esotropes who never and who always wore prescribed spectacles.

Methods: An institutional retrospective medical record review was performed for children with fully or partially refractive accommodative esotropia without neurological or other ocular disease. Only children with a least 3 years (y) follow-up, at least 2 separate cycloplegic refractions at least 3y apart, and clear documentation of full compliance and conplete non-complicance with prescribed spectacles were studied.

Results: For the right eye, average youngest (less than 2y) and oldest (8-10Y) spherical equivalents were significantly lower in non-compliant children (3.3D [n=25] and 2.49D [n=13]) than in compliant children (5.5D [n=8] and 4.69D [n=25]). The differences in mean hyperopia between less than 2y and 8-10y for the non-compliant (-0.81D) and compliant (-0.84D) children were similar as were levels of mean cylinder.

Conclusions: The differences in average spherical equivalent and average degree of astigmatism between less than 2y and 8-10 y (slight decrease and slight increase, respectively were similar for children who never and children who always wore prescribed glasses for refractive accommodatiave esotropia. Although full-time glasses wear did not appear to affect refractive shifts, limitations of this retrospective study include a lack of statistical power to detect differences less than 2D.