Clinical Report: Prisms and Vision Therapy Reduce AACE
Overview
A retrospective cohort study found that non-surgical management with prisms and vision therapy improved divergence amplitudes and reduced esodeviation in 79% of patients with acute acquired comitant esotropia (AACE). The study highlights the effectiveness of these interventions in achieving stable binocular single vision in a significant portion of the cohort.
Background
Acute acquired comitant esotropia (AACE) is characterized by sudden onset of esodeviation and diplopia in patients with previously normal binocular vision. Effective management is crucial as untreated AACE can lead to persistent visual disturbances and impact quality of life. Recent guidelines emphasize non-surgical options, including prisms and vision therapy, particularly for small to moderate deviations.
79% of patients with AACE improved with prisms and vision therapy.
Median distance esodeviation decreased by about 7 prism diopters after therapy.
Divergence amplitudes improved by approximately 7 PD at distance and 8 PD at near.
36% of patients achieved stable binocular single vision with vision therapy alone.
No patients reported diplopia after therapy with or without prism correction.
Clinical Implications
The findings suggest that non-surgical management strategies, including prisms and vision therapy, can effectively reduce esodeviation and improve divergence in patients with AACE. Clinicians should consider these options as first-line treatments for appropriate patients to enhance visual outcomes.
Conclusion
Non-accommodative, non-neurologic types of AACE can be effectively managed non-surgically in a majority of patients through a combination of prisms and vision therapy, leading to significant improvements in visual function.
Narrative review linked lower vitamin D levels to greater myopia risk and higher omega-3 intake to lower risk, though outdoor exposure may explain the vitamin D association.
