Amblyopia prevalence in patients with alternating esotropia.

PURPOSE: To determine the frequency of amblyopia in preschoolers and school-age children with alternating esotropia.

METHODS

This retrospective, cross-sectional, single-center study analyzed the preoperative medical records of patients 3-10 years of age with confirmed alternating esotropia evaluated between 2012 and January 2024. Patients with motor or cognitive disabilities, ocular pathologies, or craniofacial anomalies were excluded, as were those with prior ocular surgeries or vertical deviations. Comprehensive ophthalmic examinations assessed refractive error, visual acuity, angle of deviation, and density of amblyopia.

RESULTS

A total of 767 subjects (mean age, 6.9 ± 1.8 years; 41.4% female) with alternating esotropia were included. Of these, 151 (19.7%) were diagnosed with varying degrees of amblyopia: mild in 87 patients (57.6%), moderate in 60 (39.8%), and severe in 4 (2.7%). Thirty-seven of the amblyopic patients (24.5%) showed evidence of anisometropia; specifically, 32 (21.2%) had anisohyperopia, 4 (2.7%) had anisomyopia, and 1 (0.7%) had anisoastigmatism. Of the 616 nonamblyopic participants, 36 individuals (5.8%) had anisometropia.

CONCLUSIONS

The alternating nature of esotropia does not necessarily ensure the absence of amblyopia in children who are candidates for strabismus surgery. The high prevalence of amblyopia highlights the importance of thorough assessment and careful attention to the detection of amblyopia in this patient population.