Are Bifocals Necessary for Children with High AC/A Esotropia?

Esotropia with a high accommodative convergence-to-accommodation (AC/A) ratio is a relatively common type of strabismus in children. Typically, it presents in early childhood as esotropia greater at near than distance fixation; however, not all of these cases are considered high AC/A. If the near deviation reduces significantly when the child looks through +3.00-diopter (D) lenses, then the deviation is established as accommodative rather than the result of an excess of convergence driven by near proximity.