To study the influence of bifocal use on amblyopia treatment outcome in high accommodative convergence/accommodation (AC/A) ratio accommodative esotropia with deviation only at near.

Retrospective comparative case series.

Setting: Tertiary referral center. Patients: Children with high AC/A ratio accommodative esotropia aged 3–8 years old, with deviation only at near with glasses, neutralized with bifocal lenses (follow-up 1 year). Intervention: Amblyopia was treated with patching. We compared bifocal and single-vision glasses users at 6 months and 1 year, with control of potential confounding variables (multiple regression). Main Outcome Measures: LogMAR lines of improvement in visual acuity of the amblyopic eye, and improvement in stereoacuity.

Of 78 children, 61 were eligible. All patients wore single-vision glasses for 2 months (baseline visit), 46 of them changed to bifocals. Of 27 initially amblyopic children, 21 remained amblyopic at 2-month baseline (13 of them changed to bifocals). After adjustment for initial deviation, refraction, age, and amblyopia, improvement of visual acuity in the amblyopic eye was larger in the bifocal vs single-vision group at 6 months (mean 2.6 [95% confidence interval (CI): 1.9–2.9] logMAR lines vs mean 1.9 [95% CI: 0.5–2.2] logMAR lines, respectively, P = .01), but not at 1 year (mean 2.7 [95% CI: 2.2–3.1] logMAR lines vs mean 2.3 [95% CI: 1.6–3.1] logMAR lines, respectively, P = .3). Improvement of stereoacuity was not significantly different between the 2 groups.

Use of bifocals may provide a transient advantage, but improvement in visual acuity and stereopsis is equal with single-vision glasses over time.