Dr Wright has clearly stated that reducing the plus after surgery in an accommodative esotrope with more than +2.50 D of hyperopia may result in an unstable angle. Consequently, one should not intentionally try to overcorrect such a patient in hopes of reducing the hyperopic correction after surgery. I agree completely. It is important that he has clarified his position so unambiguously in his letter, because his previous publication may have misled the casual (and not so casual) reader.1 Data presented in that article repeatedly categorized such overcorrected patients as "successes."The abstract (which is often where the casual reader stops, and is all that is listed by online services) states that after removing as much as 3.00 D of hyperopic correction, the rate of success with augmented surgery was 98%. Consequently, the reader may not know that Dr Wright believes that these patients represent bad outcomes.
Kushner BJ. Partially Accommodative Esotropia: Should You Overcorrect and Cut the Plus?-Reply. Arch Ophthalmol. 1996;114(11):1430-1431. doi:10.1001/archopht.1996.01100140629030