I read with great interest the recent article by Chaudhuri and Demer titled “Medial Rectus Recession Is as Effective as Lateral Rectus Resection in Divergence Paralysis Esotropia.”1 In 2006, I described a similar cohort of older patients with acquired esotropia greater in the distance than at near fixation.2 I concluded, as they did, that the cause of this disorder is likely secondary to anatomical changes in the orbit and/or muscles associated with aging. Although the patients I detailed in my initial article were all treated with prism glasses, I published a second article3 in 2011 describing good surgical results in another 10 patients with this entity who were treated by adjustable-suture bilateral medial rectus recession, as were the patients described by Chaudhuri and Demer. I also agree with their assertion that the term divergence insufficiency esotropia for this syndrome is a misnomer and that the designation of divergence insufficiency esotropia should be reserved only for those patients with serious neurological disease. Yet, the authors continued to use this older name in their article. I chose to call this entity adult-onset age-related distance esotropia, which I believe better suits the findings we both described. As the population ages, we are certain to see many more patients with this entity, and I hope future investigators will use the more descriptive term of adult-onset age-related distance esotropia rather than the outmoded and inaccurate designation of divergence insufficiency esotropia. Back to top Article Information Correspondence: Dr Mittelman, Pediatric Ophthalmology Adult Strabismus Center, 1875 W Dempster, Ste 610, Park Ridge, IL 60068 (firstname.lastname@example.org). Conflict of Interest Disclosures: None reported. References 1. Chaudhuri Z, Demer JL. Medial rectus recession is as effective as lateral rectus resection in divergence paralysis esotropia. Arch Ophthalmol. 2012;130(10):1280-128422688183PubMedGoogle Scholar 2. Mittelman D. Age-related distance esotropia. J AAPOS. 2006;10(3):212-21316814172PubMedGoogle ScholarCrossref 3. Mittelman D. Surgical management of adult onset age-related distance esotropia. J Pediatr Ophthalmol Strabismus. 2011;48(4):214-21620795602PubMedGoogle ScholarCrossref
JAMA Ophthalmology – American Medical Association
Published: Apr 1, 2013
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