ORIGINAL RESEARCH article
Front. Med.
Sec. Ophthalmology
This article is part of the Research TopicNeural Mechanisms and Clinical Advances in Binocular VisionView all 5 articles
Compensatory versus Non-compensatory Types in Myopic Acute Acquired Comitant Esotropia: A New Classification Based on Fusion Ability at the Far Point
Provisionally accepted
- 1Department of Ophthalmology, Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou, China
- 2The First Affiliated Hospital of Ningbo University, Ningbo, China
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Purpose: To propose a novel classification of acute acquired comitant esotropia (AACE) with myopia based on fusion compensation ability at the far point (FP) without myopia correction (MC) and to investigate its pathogenesis in relation to eye-use habits. Design: A retrospective case-control study. Methods: This study enrolled 105 myopic AACE patients and 107 control subjects with simple myopia. Data collected included refractive error, angle of deviation (measured by prism and alternate cover test (PACT) and Maddox prism test (MPT) at distance and near), and detailed eye-use habits. AACE patients were categorized into compensatory (n=92) or non-compensatory (n=13) groups based on their ability to maintain binocular fusion at the FP without MC. Results: 98.10% of AACE patients neglected MC during prolonged near gaze before onset, a rate significantly higher than controls (13.08%). The cohort was divided into compensatory and non-compensatory groups. The compensatory group (87.62% of patients) exhibited distinct features: larger distance versus near deviation (P<0.001), greater MPT than PACT at distance (P<0.001), and near-zero deviation at the FP without MC. In this group, the convergence requirement at the FP (CRFP) showed no significant difference from MPT at distance (MPTD) (P=0.054) and was positively correlated with both MPTD and PACT at distance (PACTD) (P<0.05). In contrast, the non-compensatory group (12.38%) had a younger onset age, lower refractive error, larger deviation angles, and worse stereopsis. Conclusion: Prolonged near gaze without MC is a critical risk factor for myopic AACE. Classifying patients based on fusion compensation at the FP reveals two distinct subtypes with different clinical profiles. The compensatory type likely represents an abnormal adaptation to excessive convergence demand, whereas the non-compensatory type may indicate a decompensated mechanism. This new classification provides valuable insights for etiology and management.
Keywords: Acute acquired comitant esotropia, binocular vision, Classification, convergence, Myopia
Received: 24 Nov 2025; Accepted: 12 Feb 2026.
Copyright: © 2026 Wan, Li, Zhang, Tong, Liao, Huanyun and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Minghui Wan
Fang Zhang
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