Prisms, Vision Therapy Reduce AACE

Retrospective cohort shows 79% of patients improved without surgery, with measurable gains in divergence and reduced esodeviation

Category	Detail
Condition	Acute Acquired Comitant Esotropia (AACE)
Key Mechanisms	Non-surgical management using prisms and vision therapy to improve divergence and reduce esodeviation.
Target Population	Patients with non-accommodative, non-neurologic AACE, primarily Type II.
Care Setting	Tertiary eye care center

79% of patients showed improvement with prisms and vision therapy.
Median distance esodeviation decreased by about 7 prism diopters post-therapy.
Divergence amplitudes improved by approximately 7 PD at distance and 8 PD at near.
36% achieved stable binocular single vision with vision therapy alone.
No patients reported diplopia after therapy.

Evaluate patients for non-accommodative, non-neurologic AACE.
Exclude patients with accommodative, decompensated, neurologic, cyclic, or secondary forms of AACE.

Prescribe Fresnel prisms for constant diplopia, focusing on the smallest effective magnitude.
Implement divergence-focused vision therapy, including in-office and home-based exercises.

Assess changes in negative fusional vergence and esodeviation before and after therapy.

34 patients evaluated, 14 included in analysis with Type II AACE.

Vision therapy alone may suffice for esodeviation of 20 PD or less; larger deviations often require combined therapy.

Utilize a combination of prisms and vision therapy for effective management of AACE.
Encourage regular follow-up and maintenance exercises post-therapy.