Q & A – Accommodative Esotropia

istock 184621527 e1481559336815Q: My daughter is 13 and has a lazy eye that tends to cross inwards. She was told she has to wear bifocals. Why would that be, if she is so young?

A: It sounds like your daughter has what we refer to as accommodative esotropia. It is among the most common causes for a crossed or lazy eye and it describes the eyes’ exertion in effort to focus clearly. This effort of focusing the eyes is called accommodation. Whenever we focus on a near object, this powerful focusing force also activates the turning inward of the eyes to align upon the object. These 2 activities are both controlled by the same nerve and happen at the same time. However, when the two systems become imbalanced, accommodative esotropia often develops.

Children typically have a lot of focusing power, or accommodation, but your daughter’s ability to see clearly depends on additional focusing to overcome the abnormally high degree of farsightedness. It seems that your daughter’s eye doctor has determined that she has a particularly excessive amount of esotropia at near vision and that is why she is considered for bifocal lenses instead of “regular” glasses. Unlike middle-aged adults, children adapt to bifocals very well, even when playing sports such as soccer. The key is to ensure your child wears the bifocals consistently and at all waking hours to maintain good vision in each eye.

In most cases, children will eventually outgrow accommodative esotropia. However, this condition takes several years and it usually does not occur before the age of 12. It is difficult to determine if a particular child will indeed outgrow their need for glasses, but approximately half the children who require bifocals do in fact outgrow it.

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