It has been suggested that near esophoria is associated with more rapid myopia progression than for people with orthophoria and exophoria. It has also been stated that there is a shift towards esophoria during myopic progression. Young people with near esophoria are thought to relax their accommodation in an attempt to relax their convergence at near to help maintain comfortable binocular single vision. The reduced accommodation as a result could promote axial elongation because of hyperopic blur at the central retina. In other studies, children who developed myopia also showed an elevated AC/A ratio in the several years prior to myopia development compared to those who remained emmetropic.

The evidence for a link between myopia progression and near esophoria and myopic progression and a high AC/A ratio is not clear. There are studies, which show that there is no link.

However, there is a line of thought that young people with low myopia with near esophoria, high AC/A ration and accommodative lag may benefit from executive bifocals when other treatment options such as myopia management contact lenses are contraindicated. They may respond to this treatment modality compared to young people with low myopia but without these binocular vision anomalies.

I think that overall it is worth trying executive bifocal spectacle lenses in these cases for myopia management. Every less dioptre of myopia means a reduced risk for serious eye disease in later years.

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