Treatment of esotropia with a high AC/A ratio

We have treated 55 children with accommodative esotropia and high AC/A ratio with progressive addition lenses, measured by heterophoria method. All of them wear full hyperopic refraction for distance and addition of +1.00 to 3.5 spheres for near vision. The minimal add that allowed the maximal reduction in the near deviation was prescribed appointed to follow-up control three months after the use of the new lenses, and thereafter every six months. A progressive reduction of the abnormally high AC/A ratio (difference between distance and near deviation measurements) showed 45 children (81.81%) but ten of them (18.19%) deteriorated into non-accommodative esotropia requiring surgical treatment. The age of initial use of progressive-addition lenses ranged from 26 months to 7 years (average: 63.2 months). The age of onset of the esotropia ranged from 7 months to 82 months (average: 28.7 months). The initial add was of +3.00 diopters in 39 children (70.8%). The mean add prescription for whole study group was 2.96 diopters. A progressive improvement of the AC/A ratio achieving normal after a mean of 18 to 24 months in a significant number of cases.