I read with great interest the recent article by Chaudhuri and Demer titled “Medial Rectus Recession Is as Effective as Lateral Rectus Resection in Divergence Paralysis Esotropia.”1 In 2006, I described a similar cohort of older patients with acquired esotropia greater in the distance than at near fixation.2 I concluded, as they did, that the cause of this disorder is likely secondary to anatomical changes in the orbit and/or muscles associated with aging. Although the patients I detailed in my initial article were all treated with prism glasses, I published a second article3 in 2011 describing good surgical results in another 10 patients with this entity who were treated by adjustable-suture bilateral medial rectus recession, as were the patients described by Chaudhuri and Demer.
Mittelman D. Divergence Insufficiency Esotropia Is a Misnomer. JAMA Ophthalmol. 2013;131(4):547–548. doi:10.1001/jamaophthalmol.2013.1584
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