Axial Length and the Response to Strabismus Surgery-Reply

In Reply.  —Wilson and McClatchey raise important questions that deserve careful analysis. Because it has been shown that esotropes with a high accommodative convergence/accommodation ratio or a nonaccommodative convergence excess do require larger amounts of surgery than other esotropes,¹ we intentionally excluded such patients from our study. We only included acquired esotropes in whom the near deviation and distance deviation were approximately equal. We are surprised that Wilson and McClatchey believe that this group of esotropes requires a larger amount of surgery for a given deviation than congenital esotropes. All of the popular strabismus textbooks and journal articles we are aware of do not recommend a different surgical formula for congenital esotropes than for decompensated accommodative esotropes in whom the near deviation equals the distance deviation. We therefore thought it was appropriate to combine these two patient groups in our study. Nevertheless, because of the questions raised by Wilson