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.

Data Highlights

Key Findings

• 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.

References

1. PLOS One, 2023 -- Management of acute acquired comitant esotropia using prisms and vision therapy
2. Optometric Management, 2024 -- Prescribing prism
3. Eyecare Business, 2012 -- Understanding Prism Part 2: Verifying Prescribed and Unwanted Prism
4. PubMed, 2024 -- Adult Strabismus Preferred Practice Pattern®
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9. Adult Strabismus Preferred Practice Pattern® - PubMed
10. Management of acute acquired comitant esotropia using prisms and vision therapy - PMC