Accomodative Esotropia

Views:
 
Category: Education
     
 

Presentation Description

Accomodative Esotropia

Comments

Presentation Transcript

Title:

Title Accommodative Esotropia Dr. Huseynova Tukezban Chairman of ADMO YO. Baku, Azerbaijan tukezban@gmail.com www.admo.org.az

Title:

Title An esotropia caused by an increased accommodative effort or an abnormally high AC/A ratio is referred to as ‘‘accommodative’’ esotropia .

Title:

Title Characteristics of the patient with accommodative esotropia. Onset between 6 month and about 7 years (average between 2-3 years) Usually intermittent at the start Often hereditary Can come after illness May have transient diplopia Angle usually 30-40 prism diopters

Title:

Title Subgroups of accommodative esotropia Refractive Accommodative Esotropia (Normal AC/A Ratio) Nonrefractive Accommodative Esotropia (High AC/A Ratio) Hypoaccommodative Esotropia

Title:

Title Refractive Accommodative Esotropia (Normal AC/A Ratio)

Title:

Title Definition Refractive accommodative esotropia is defined as an esotropia that is restored to orthotropia at all fixation distances and in all gaze positions by optical correction of the underlying hypermetropic refractive error.

Title:

Title Etiology Uncorrected hypermetropic refractive error Retinal image blur Makes no effort to accomodate Orthotropia Bilateral ametropic amblyopia

Title:

Title Etiology Accommodation Accommodative Convergence Insuffficient fusional divergence Normal or high AC/A ration Sufficient fusional divergence Low or flat AC/A ratio Refractive accommodative esotropia Esophoria May not become esotropic in spite of uncorrected hypermetropia

Title:

Title A: Refractive-type accommodative esotropia . B: A left esotropia is eliminated with the use of glasses. Clinical Evaluation

Title:

Title Refractive esotropia (RAET) without hyperopi c glasses Refractive esotropia (RAET) with hyperopic glasses Clinical Evaluation

Title:

Title Therapy Full correction of the hypermetropic refractive error, determined by cycloplegic refraction,

Title:

Title Therapy The cycloplegic refraction is repeated annually.

Title:

Title Therapy Miotics be substituted for glasses in certain patients with refractive accommodative esotropia. =

Title:

Title Nonrefractive Accommodative Esotropia (High AC/A Ratio)

Title:

Title Definition Nonrefractive accommodative esotropia is defined as an esotropia greater at near than at distance fixation, unrelated to an uncorrected refractive error, and caused by an abnormally high AC/A ratio in the presence of a normal near point of accommodation.

Title:

Title The etiology Abnormal synkinesis between accommodation and accommodative convergence—the effort to accommodate elicits an abnormally high accommodative convergence response.

Title:

Title The etiology Measurement of AC/A and CA/C ratios As: accommodative stimulus, Ar: accommodative response, AC: accommodative convergence, C: convergence, CA: convergence accommodation.

Title:

Title Clinical Evaluation The diagnosis of nonrefractive accommodative esotropia is based on the presence of a significant esodeviation at near fixation on an accommodative fixation target

Title:

Title Clinical Evaluation Most patients with nonrefractive accommodative esotropia present between the ages of 6 months and 3 years.

Title:

Title Clinical Evaluation A child with refractive RAE with CE showing Right esodeviation without refractive correction, Reduced esodeviation with spectacle correction, Orthotropia with spectacle correction and +3.0 D addition, and Orthotropia under cycloplegia * Refractive accommodative esotropia (RAE) *Convergence excess (CE)

Title:

Title Clinical Evaluation A. left esodeviation without refractive correction, B. residual esodeviation with spectacle correction, C. residual esodeviation with spectacle correction and +3.0 D addition, and D. residual esodeviation under cycloplegia

Title:

Title Accommodative esotropia of the high accommodative convergence “to “accommodation ratio type. A. The esotropia at near viewing is eliminated B. with the use of bifocals. Clinical Evaluation

Title:

Title Therapy Treatment with bifocal lenses are ideal.

Title:

Title Hypoaccommodative Esotropia

Title:

Title Definition Hypoaccommodative esotropia is defined as an esotropia greater at near than at distance fixation, unrelated to an uncorrected hypermetropic refractive error and caused by excessive convergence from an increased accommodative effort to overcome a primary or secondary weakness of accommodation.

Title:

Title This form is characterized by a small refractive error, a remote near point of accommodation, a small deviation at distance fixation, but a large esotropia at near fixation. Clinical Evaluation

Title:

Title When and What types of bifocals Bifocal should be employed only if they reduce the near angle to ortho and allow single binocular vision. Especially for young children the bifocal top should be flat and bisect the pupil. There is no universal agreement on how and when to wear a patient from bifocals. Some reduce the power gradually and others stop the bifocal entirely rather than gradually reduce them. Some prefer bimedial faden or even recession in the process of dealing with a persistent near deviation.

Title:

Title Thank You

authorStream Live Help