Content area
Full Text
For proper management of accommodative esotropia, the full magnitude of the accommodative component should be elicited; there is general agreement that surgery is inappropriate for the eyes that can be straightened by measures that curb accommodative effort, and that in a convergent strabismus with both accommodative and nonaccommodative components, only the latter portion calls for operative correction.1
The usual procedure in the investigation of the esotropic patient is to prescribe either anticholinesterase drops or plus lenses (single vision or bifocal) and to allow a trial of at least several weeks' duration before reassessing the alignment. It would be useful to have a rapid indicator of whether such a therapeutic trial is likely to be even partially successful in straightening the overconverged eyes or, equally important, likely to be a complete failure.
It is desirable to keep the techniques of strabismus examination as simple as possible. The test to be described employs an already familiar method of evaluating a misalignment, and this description is merely an extended application.
Comparing alignments at near fixation with and without the subject wearing + 3.00 D lenses is a widely used method of differentiating between so-called "true" and "pseudo" divergence excess types of exodeviation.2 It can be quite valuable in convergent deviations as well. Comparing the magnitudes of esodeviation at near with and without +3.00 D lenses being worn not only can indicate the presence of a significant accommodative component at near in both the normal and the high AC/A ratio patient, but can give important information about the existence of an uncompensated accommodative element at distance, even before any determination of the refractive error has been made and the compensating lenses worn. Moreover, in the patient already under treatment and not completely straightened by measures which lessen accommodative effort, this test, done at near fixation, can in several instances indicate the likelihood of any remaining accommodative component of the distance misalignment, and predict the effectiveness of further nonsurgical treatment. It is more effective in older children, in whom control of accommodation by demanding visual attention and verbal responses can be more reliably secured.
In this test, with accommodation controlled as well as possible, by requiring the subject to fixate and identify objects with fine details, the alignments are...