Accommodative Esotropia or esophoria

I noticed something a little off about my sons eyes that no one else noticed but thought I should have his eyes checked.  I took him to an opthomologist that sees adults and kids and he was diagnosed with Esophoria and prescribed glasses +1.50.  I got a second opinion with a pediatric opthomologist and she diagnosed him with Accommodative Esotropia, and prescribed bifocals with a prescription of +2.50.....with pupil measure high.  Now I am uterlly confused and not sure what to do.  Suggestions?

[John C Hagan III, MD, FACS, FAAO]

I would go with the pediatric ophthalmologist. That's all they do is treat strabismus (eye muscle problems). They have additional training (Fellowship) in eye muscles problems. This is very important as this can lead to an eye that doesn't see well (amblyopia) and to a crossing that gets bigger and becomes permanent requiring surgery. By the way surgery is not a substitute for glasses in accommodative esotrophia.

JCH III MD

[mooduk]

Ajoy - I can emphathise with your confusion!  Our daughter has alternating, intermittent esotropia with an inability to accomodate.  Which apparently isn't quite the same thing as accomodative esotropia because she won't grow out of it (she has a brain injury).  The ophthalmologist prescribed glasses for her far-sightedness (+3.00) and put a +3.75 bifocal on top of that  The stronger than usual bifocal is to compensate for the close distance she holds her materials because of her cerebral visual impairment.  The first optometrist she saw prescribed only a +1.50 with no bifocal and that didn't help at all.  The next ophthalmologist prescribed glasses with bifocals of +3.00.  The stronger bifocals (+3.75) have helped a lot.  She wasn't able to write at all until she got her first bifocal and her writing really improved when she got her stronger bifocals.  Its my understanding that pediatric ophthalmologist like the bifocal to bisect the pupil as that makes it easier for the child to use them.  Adults know to look down to use their bifocal but kids don't.  Hope that helps.  Mooduk

[John C Hagan III, MD, FACS, FAAO]

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