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November 1996

Partially Accommodative Esotropia: Should You Overcorrect and Cut the Plus?

Author Affiliations

Cleveland, Ohio

Arch Ophthalmol. 1996;114(11):1429-1430. doi:10.1001/archopht.1996.01100140629029

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Dr Kushner's article,1 published in the December issue of the Archives, made several references to an article on which I was the first author, entitled "Augmented Surgery for Esotropia Associated With High Hypermetropia."2 Unfortunately, there seem to be some misunderstandings that require clarification. Dr Kushner describes our article as advocating intentional surgical overcorrection in patients with partially accommodative esotropia, so that "the need for hypermetropic correction after surgery may be reduced or eliminated." I regret that our article may have given Dr Kushner this impression. I have never advocated operating to reduce or remove hypermetropic spectacle correction, nor do I know of any article published in the United States that advocates this practice. The goal is to achieve orthophoria and binocular fusion with the patient wearing the full hypermetropic correction. Of the 40 patients in our study undergoing augmented surgery, 35 (88%) required the full hypermetropic correction. Two

Kushner BJ.  Partially accommodative esotropia: should you overcorrect and cut the plus? Arch Ophthalmol . 1995;113:1530-1534.Article
Wright KW, Bruce-Lyle L.  Augmented surgery for esotropia associated with high hypermetropia . J Pediatr Ophthalmol Strabismus . 1993;30:167-170.
Prism Adaptation Research Group.  Efficacy of prism adaptation in the surgical management of acquired esotropia . Arch Ophthalmol . 1990;108:1248-1256.Article
Parks MM, Wheeler MB.  Concomitant esodeviations . In: Tasman W, Jaeger EA, eds. Duane's Clinical Ophthalmology: Ocular Motility and Strabismus . Philadelphia, Pa: Lippincott-Raven Publications; 1995:10.
Basic and Clinical Science Course Committee.  Surgery of the extraocular muscles . In: Basic Clinical Science Course: Pediatric Ophthalmology and Strabismus . San Francisco, Calif: American Acadamy of Ophthalmology; 1996;6:10.
Jotterand VH, Isenberg SJ.  Enhancing surgery for accommodative esotropia . Ophthalmic Surg . 1988;19:263-266.