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Ultranear Testing in Accommodative Esotropia

Purpose: To determine if patients with accommodative esotropia controlled with glasses maintain ocular alignment at viewing distances less than 1/3 m.

Design: Prospective case-control study.

Methods: Thirty children with refractive-type accommodative esotropia were evaluated for ocular alignment at 6 m, 1/3 m, and 1/6 m ("ultranear") using accommodative targets. Ten children without strabismus served as controls.

Results: Twenty-eight of 30 (93%) of children with otherwise controlled accommodative esotropia exhibited a manifest deviation of 5 to 16 when measured at ultranear. Excessive accommodation appeared to be present in at least some accommodative esotropes. Regardless of viewing distance, esophoria or esotropia was not elicited in control patients (P <0.0001).

Conclusion: Children with refractive accommodation esotropia demonstrate excess convergence at very close testing distances. Excess accommodation may partly explain this observation.

Key words: Convergence, accommodation, accommodative esotropia