Vision Therapy Improves Fusion in Acute Acquired Comitant Esotropia

Vision therapy may be a viable method of treating acute acquired comitant esotropia, particularly when used in conjunction with prismatic correction, according to a poster presented at the American Optometric Association 2023 ePosters Virtual Event from June 13-14, 2023 in Washington, DC. This treatment method may allow improved divergence, reduce the amount of base out prism needed to obtain fusion, and present an alternative to botulinum toxin therapy or surgical treatment, according to the report. 

Anthony Boyd, OD, Siva Meiyeppen, OD, and Kelly A. Malloy, OD, of Salus University detailed a case report of a girl (age, 13 years; White) presenting with lateral diplopia who reported a sudden onset 2-years ago that was more prominent at distance than at near. The patient wore myopia-correcting spectacles with base out prism, which provided relief from frontal headaches. The patient underwent magnetic resonance imaging (MRI) of the brain and orbits with and without contrast and no causative pathology was determined. The team discussed various treatment options with patient and all parties agreed to vision therapy treatment.

The patient underwent 23 vision therapy sessions — each was 45 minutes in duration. At follow-up visits conducted 3 and 6 months following treatment, no diplopia was present, according to the report. The patient achieved fusion on Worth 4 Dot assessment at all distances and global stereopsis. Prism correction was no longer needed following the intervention. 

“The literature currently highlights prism, surgery, and botulinum toxin type A injection as effective treatment approaches,” the posted presenters explain. “There is little evidence on the effectiveness of vision therapy in the management of these patients. This case highlights the possibility of integrating both prismatic correction and divergence therapy as an alternative treatment method.”