Session: Free papers Session I - Esotropia 1

Prism adaptation test vs. standard orthoptic measurement before surgical treatment of decompensated esophoria

Mikael HOFSLI¹, Tobias TORP-PEDERSEN¹, Steffen HAMANN¹, Anton POTTEGÅRD², Jon Peiter SAUNTE¹, Claes SEPSTRUP LØNKVIST¹, Mark ALBERTI¹, Morten DORNONVILLE DE LA COUR¹

¹Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Glostrup, Denmark
²Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, Odense, Denmark

Introduction

Decompensated esophoria is a latent esodeviation that progresses into a manifest esotropia, causing substantial discomfort such as diplopia, headaches, and asthenopia. Surgery for esophoria is prone to undercorrection, and prism adaptation test (PAT) has revealed significantly larger angles of deviation (AOD) compared to standard orthoptic evaluation in this patient group. The aim of this study was to compare AOD and reoperation rates between PAT performed vs. standard orthoptic evaluation only in patients who underwent surgery for decompensated esophoria.

Methods

Records of patients with decompensated esophoria who underwent surgery at the Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen University Hospital, Denmark, from January 1, 2017, to December 31, 2022, were reviewed. Demographics, medical, and ophthalmological histories were collected. Clinical evaluations included a full ophthalmological examination and orthoptic assessment. Patients were divided into two groups: non-PAT and PAT-group, based on whether prism adaptation was conducted. Duration of PAT lasted from one-half to two hours.

Results

Ninety-seven patients were included, with 59 in the non-PAT group and 38 in the PAT group. Baseline mean AOD at near (AODn) in the non-PAT group was 18.8 ± 9.06 prism diopters (PD), and AOD at distance (AODd) was 18.58 ± 5.89 PD. In the PAT group, mean AODn was 15.39 ± 8.32 PD, and AODd was 15 ± 5.85 PD. After PAT, a significant increase in mean AODn (30.32 ± 10.22 PD, p < 0.05) and AODd (30.95 ± 8.34 PD, p < 0.05) was observed. Reoperation or postoperative adjustments were significantly less frequent in the PAT group (n=9/38) compared to the non-PAT group (n=27/59) (p < 0.05).

Conclusions

Decompensated esophoria patients exhibit notable AOD increase after PAT. Surgical decisions based on PAT decreases the likelihood of postoperative adjustments or reoperations.