Early alignment versus delayed alignment in patients with hyperopia and esotropia

PurposeTo compare the clinical outcomes in hyperopic and esotropic patients with and without early alignment after spectacle correction.MethodsThe medical records of patients with hyperopia and esotropia who were initially treated at a single center with full spectacle correction of their hyperopia from 1994 to 2009 were retrospectively reviewed. Patients with ≤10Δ of residual esotropia after 2 months were assigned to the early-alignment group; those with >10Δ were assigned to the delayed-alignment group. The main outcome measure was final stereoacuity of each group.ResultsOf 136 patients who met the inclusion criteria, 85 (63%) were aligned after 2 months, whereas 51 (37%) had residual esotropia. The early-alignment group had more patients with high-grade stereoacuity ≤100 arcsec (37% vs 19%) and significantly better stereoacuity results overall (P = 0.037). Almost 70% of patients with poor alignment at 2 months required strabismus surgery, whereas 30% improved after over 1 year in spectacles alone, achieving a final alignment of ≤10Δ without surgery.ConclusionsThese results suggest that earlier correction of esotropia results in better final stereoacuity. The desire for early correction, however, should be tempered by the knowledge that 30% of patients with poor early alignment may eventually achieve alignment without surgery, a result that should be considered when counseling parents about the need for strabismus surgery.