Increasing incidence and risk factors for divergence insufficiency esotropia

J AAPOS. 2021 Sep 25;S1091-8531(21)00527-9. doi: 10.1016/j.jaapos.2021.05.013. Online ahead of print.


Purpose: To document the increasing incidence of divergence insufficiency (DI) esotropia and to identify risk factors for DI.

Methods: All patients with a diagnosis of esotropia seen by one provider (DLG) over 41 years were identified from the medical record. Patients with onset of strabismus before age 10 years or with prior strabismus surgery were excluded. Cases of esotropia associated with thyroid eye disease, scleral buckles, trauma, neurological diseases, or atypical misalignment were included but not labeled as DI regardless of the distance versus near deviation. The remaining patients, whatever the original diagnosis, were retrospectively categorized as having, or not having, DI, using a uniform criterion: distance esotropia ≥5Δ more than near esotropia.

Results: The percentage of DI patients among acquired esotropia patients increased significantly between the first and second half of the 41-year period, from 11.8% to 29.4% (P < 0.001). Multivariate logistic regression identified advancing age and the use of progressive addition lenses as risk factors for the development of DI.

Conclusions: The incidence of DI is increasing. DI's association with age and progressive addition lenses may help us to understand its etiology and to decrease the prevalence of this condition in the future.