A 9-year-old healthy boy presents for follow-up with a 7-year history of esotropia (ET). When first evaluated at 2 years of age, he had a manifest deviation of 30 ET with a strong fixation preference for the left eye. Cycloplegic refraction was +4.00 right and +2.50 + 0.50 x 90 left. At this time, he was diagnosed with refractive-accommodative esotropia (RAET), anisometropia, and probable amblyopia of the right eye. Treatment was initiated with full-time wearing of full-plus glasses. When visual acuity testing was possible at 4 years of age, his acuity measured 20/125 right and 20/40 left. Therefore, part-time occlusion of the left eye 3-4 hours daily was started for amblyopia of the right eye. At 6 years of age, his visual acuity measured 20/125 right and 20/80 left and he was then diagnosed with bilateral amblyopia. Amblyopia occlusion therapy was discontinued at 8 years of age, with visual acuities measuring 20/100 right and 20/70 left.
Now, at 9 years of age, visual acuity with correction is 20/200 right and 20/60 left. Cycloplegic refraction measures +5.00 sphere right and +3.75 + 2.00 x 80 left. Ocular motility is normal but alternate cover testing reveals a small residual strabismus of 10 E(T) with distance fixation and 6 E(T) with near fixation. Fundus photos taken at the most recent examination are shown below.