In the management of accommodative esotropia with high AC/A ratio, the preferred optical correction approach is:

• A Full hypermetropic correction with bifocal add for near ✓
• B Under-correction of hypermetropia by 1.5 D to stimulate accommodation
• C Monovision correction with one eye corrected for distance and other for near
• D Prism glasses with base-out prisms to neutralize the deviation

Explanation

High AC/A ratio accommodative esotropia involves a disproportionately large convergence response per diopter of accommodation, causing esotropia at near but not (or less) at distance. Management requires full hypermetropic correction (to minimise accommodative demand) combined with a bifocal add (typically +3.00 D) to reduce the accommodation (and thus convergence) needed for near. Executive or flat-top bifocals are used in children. Surgery alone does not correct the AC/A ratio mechanism; atropine penalisation may also help.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.