Improvement in motor development following surgery for infantile esotropia

doi:10.1016/j.jaapos.2007.08.013

Journal of American Association for Pediatric Ophthalmology and Strabismus

Volume 12, Issue 2, April 2008, Pages 136-140

Presented at the 33rd Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, Seattle, Washington, April 11-15, 2007.

https://doi.org/10.1016/j.jaapos.2007.08.013 Get rights and content

Purpose

Infantile esotropia is associated with abnormal visual development and thus may delay the achievement of developmental milestones. Although early surgery can improve visual function, less is known about its effect on motor development. Here we address whether early surgery can improve motor development.

Methods

Recently, our lab devised the Infant Developmental Skills Survey, a 25-item questionnaire designed to assess sensorimotor and gross motor development. The questionnaire was completed by the parents of 3- to 10-month-old patients with infantile esotropia prior to surgery (n = 143) and the parents of 6- to 11-month-old patients following surgery (n = 58). A subset of parents (n = 40) completed the questionnaire both before and after surgery. For comparison, the questionnaire was completed by the parents of infants with normal ocular alignment (n = 194).

Results

Before surgery 4-, 5-, 6-, 7-, 9-, and 10-month-old patients showed delayed achievement of sensorimotor milestones (p < 0.01), and 5-, 9-, and 10-month-old patients demonstrated delayed attainment of gross motor milestones (p < 0.05) compared with normal children. However, following surgery, patients demonstrated a greater rate of sensorimotor development than age-matched controls (p < 0.0001) and caught up with normal children on both sensorimotor and gross motor skills.

Conclusions

Prior to surgery, patients with infantile esotropia were delayed in their achievement of developmental milestones. However, following surgery, a comparison group of patients showed rapid development and possessed motor skills comparable to those of normal children, suggesting that early surgery is beneficial to both visual and motor development.

Section snippets

Participants

Participants included 161 patients diagnosed with infantile esotropia with constant esodeviations of ≥30^Δ. Patients ranged from 3 to 11 months of age and were referred by 14 pediatric ophthalmologists in the Dallas-Fort Worth area. All patients were diagnosed by 6 months of age and average age at surgery was 7.1 months (SD = 1.8 months). All patients were free from neurological and systemic disorders. For comparison, a control group of 194 three- to 11-month-old, full-term, healthy infants with

Presurgery Group versus Control Group

Sensorimotor and gross motor scores of the presurgery group are compared with those of the control group as a function of age in Figure 1A and B. Relative to the control group, the presurgery group showed delayed achievement on both sensorimotor milestones (F_1,311 = 70.09, p < 0.0001) and gross motor milestones (F_1,311 = 13.75, p < 0.0005). Planned comparisons indicated that the delay of sensorimotor milestones was significant at 4, 5, 6, 7, 9, and 10 months of age (p < 0.01). Delay of gross

Discussion

Our findings indicate that children with infantile esotropia exhibited delayed achievement of developmental milestones prior to surgery. The impairment of sensorimotor development was particularly profound and was evident at virtually all ages assessed. This result is predictable as the majority of sensorimotor milestones included in the questionnaire are visually demanding (eg, grasping a toy, grasping tiny objects, following a moving toy). Therefore, if a child has abnormal binocular function

Acknowledgment

The authors thank Christina S. Cheng and Lauren Wyatt for their assistance in data collection.

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Application of bifocal and progressive addition lenses in the management of accommodative esotropia: A comprehensive review of current practices
2022, Survey of Ophthalmology
Nonrefractive accommodative esotropia (NRAET) is a form of pediatric acquired strabismus in which the accommodative convergence to accommodation (AC/A) ratio is high. Accordingly, the near angle of esotropia is notably greater than the distance angle, and after full-cycloplegic correction, the near angle is not fully resolved. Nonsurgical plans to deal with convergence-excess esotropia include observation only and single vision lenses with or without a ground-in plus addition power. Bifocals and progressive addition lenses (PALs) are two available designs when the preferred management approach is near plus addition. There are inconsistent data regarding the practical effectiveness of these two optical modalities in providing ocular alignment. Several studies advocated using bifocals and PALs as the primary management strategy in patients with NRAET; however, because of developmental concerns, others affirm that early surgical intervention can be a more conservative strategy than optical treatment. They noted that this method might be ineffective or even pernicious due to the need to defer the surgical intervention. In practice, the prescription of near plus addition lenses in the two forms of bifocals and PALs could be a double-edged sword in the treatment course of patients with NRAET. Therefore, an individualized approach according to the age, degree of refractive error, AC/A ratio, esotropia angle at distance and near, coexisting amblyopia, and parents’ economic and cosmetic concerns would be important before choosing any treatment option.
Strabismus Surgery Decreases the Risk of Injuries in Pediatric Patients in the OptumLabs Data Warehouse
2022, American Journal of Ophthalmology
Citation Excerpt :
Despite this strong evidence for subnormal motor skills in strabismic children, there is little research related to whether motor skills improve after strabismus surgery. In 2008, a study of infants less than 1 year of age undergoing surgery for infantile esotropia evaluated the results of a parental survey on gross motor skills via the Infant Developmental Skills Survey before and after surgery.19 The results of the parental surveys suggested that children with infantile esotropia had delayed attainment of gross motor milestones preoperatively, but there was a catch-up to age-matched peers postoperatively.
Previous studies have shown an association between injury risk and strabismus in aged Medicare beneficiaries and children. The injury prevalence in strabismic children was 30% in a study of >10 million patients in the OptumLabs Data Warehouse. The purpose of this study was to determine whether strabismus surgery decreases the risk of injury.
Retrospective cohort study.
The OptumLabs Data Warehouse is a deidentified, longitudinal health database that was queried for strabismic patients aged <19 years. The patients who underwent strabismus surgery were compared with those strabismic patients who did not undergo surgery for injury. Injury risk (fractures, musculoskeletal injuries, and head injuries) during their insurance enrollment was calculated in the nonsurgical patients after their first strabismus claim and compared with the risk in surgical patients postoperatively.
There were 344,794 patients with strabismus. Surgery was performed in 26,459 (7.7%). Esotropia was the most common diagnosis (n = 181,195, 52.6%) followed by exotropia (n = 161,712, 46.9%) and hypertropia (n = 43,831, 12.7%). Within these groups, patients with hypertropia were significantly more likely to undergo surgery (24.2%) compared with patients with esotropia and exotropia (10.2% and 9.6%, respectively). Injuries were diagnosed after the first strabismus claim in 94,960 (29.8%) nonsurgical patients vs 5790 (21.9%) postsurgical patients (P < .001) with a mean follow-up of 4.3 ± 3.1 vs 3.8 ± 3.1 years, respectively. The adjusted hazard ratio for injuries was 0.85 (95% confidence interval [CI]: 0.83-0.87) for the risk of any injury after strabismus surgery. The hazard ratio was significantly decreased after surgery for each type of strabismus: esotropia (0.91, 95% CI: 0.88-0.94), exotropia (0.82, 95% CI: 0.80-0.85), and hypertropia (0.89, 95% CI: 0.85-0.93).
Strabismus surgery was associated with a 15% decrease in the risk of physical injury over approximately 4 years of follow-up. Surgery may be a factor in decreasing injury risk in strabismic patients, particularly in exotropia. Given the large number of children with strabismus in the United States, further assessment of strategies such as strabismus surgery to reduce injuries in children with strabismus is needed.
Risk of physical injuries in children and teens with ophthalmic diagnoses in the OptumLabs Data Warehouse
2021, Journal of AAPOS
To evaluate how eye diseases affect the risk of injuries (fractures, musculoskeletal, head and eye injuries) in children and teens.
Claims from the OptumLabs Data Warehouse, a longitudinal deidentified commercial insurance claims database, were analyzed. Eligible subjects were aged <19 years at the time of their eye disease diagnosis, enrolled in the health plan between 2007 and 2018, and had >1 visit for >1 significant eye disease (strabismus, amblyopia, nystagmus, structural diseases), based on ICD9/10 codes. Controls were children in the same database who had no eye disease codes reported. Demographics and injury claims (fractures, musculoskeletal injuries, head injuries and eye injuries) were compared.
The overall incidence of any subsequent physical injury (even into adulthood) was 29% in eye disease patients and 23% in controls (P < 0.001). After accounting for covariates, the hazard ratio for injury with any type of eye disease was 1.14 (95% CI, 1.13-1.15), 1.17 (95% CI, 1.16-1.18), 0.97 (95% CI, 0.96-0.98), and 1.63 (95% CI, 1.60-1.66) for musculoskeletal injuries, fractures, head injuries, and eye injuries, respectively. The eye disease with the highest adjusted injury risk was nystagmus (HR = 1.26; 95% CI, 1.23-1.28), followed by optic neuritis and pseudotumor cerebri (HR = 1.25). The eye diseases with the lowest risk included amblyopia, esotropia, and glaucoma (HR ≤ 1.06).
There was an increased long-term risk of physical injury among children and teens with eye disease. The clinical significance of these small differences is unclear.
Maternal smoking during pregnancy and long-term ophthalmic morbidity of the offspring
2021, Early Human Development
Citation Excerpt :
Solberg and his colleagues [25] demonstrated how prenatal exposure to smoking significantly increases the risk for esotropia (a sub-category of visual disturbance). The importance of this finding was demonstrated over a decade ago when Drover and his colleagues [26] showed how children with esotropia had reached motor development milestone slower than their counterparts. A systematic review published in 2015 [15] had found higher rates of strabismus (both esotropia and exotropia), refractive errors (both of which belong to the sub-category of visual disturbance) and retinopathy, among children of women who smoked during pregnancy.
To examine whether smoking during pregnancy is correlated with long-term ophthalmic complications of the offspring.
A population-based cohort analysis was performed comparing all deliveries of mothers who reported smoking during pregnancy and non-smoking mothers between 1991 and 2014 at a single tertiary medical center. Hospitalizations of the offspring up to the age of 18 years involving ophthalmic morbidities were evaluated according to a predefined set of ICD-9 codes. A Kaplan-Meier curve was used to compare cumulative hospitalization rate in exposed and unexposed offspring and a Cox proportional hazards model was used to control for confounders.
During the study period, 243,680 deliveries met the inclusion criteria. Of them, 2965 (1.2%) were children of smoking mothers. Ophthalmic-related hospitalizations were significantly higher in children born to smoking mothers, as compared with the non-smoking group (1.4% vs. 0.1%, p < 0.01). Specifically, these hospitalizations were due to higher rates of visual disturbance rate and ophthalmic infections. The Kaplan-Meier curve demonstrated a significant higher cumulative incidence of ophthalmic-related hospitalizations in the smoking group (log rank p < 0.001). Using a Cox proportional hazards model, controlling for potential confounders, maternal tobacco use was found to be independently associated with long-term ophthalmic morbidity of the offspring (adjusted HR = 1.51, CI 1.11–2.04).
Maternal smoking during pregnancy is an independent risk factor for long-term ophthalmic morbidity of the offspring. These results are in line with many recent studies that strongly support maternal smoking cessation during pregnancy due to high offspring morbidity risk.
Global motion perception is related to motor function in 4.5-year-old children born at risk of abnormal development
2017, Vision Research
Citation Excerpt :
The secondary aim of this study was to investigate the relationships between clinical measures of visual function (stereopsis and visual acuity) and visuomotor control in the same group of children. Disorders of binocular vision such as amblyopia and strabismus disrupt normal development of visually guided reaching and grasping (Grant & Conway, 2015; Grant & Moseley, 2011; Grant, Suttle, Melmoth, Conway, & Sloper, 2014; Grant et al., 2007; Mazyn, Lenoir, Montagne, Delaey, & Savelsbergh, 2007; Melmoth et al., 2009; O’Connor, Birch, Anderson, & Draper, 2010b; Suttle, Melmoth, Finlay, Sloper, & Grant, 2011) and impair performance on standardized tests of fine motor function (Caputo et al., 2007; Drover, Stager, Morale, Leffler, & Birch, 2008; Hrisos, Clarke, Kelly, Henderson, & Wright, 2006; Rogers, Chazan, Fellows, & Tsou, 1982; Webber, Wood, Gole, & Brown, 2008; Webber, Wood, & Thompson, 2016). However, the relationship between stereoacuity and fine motor function in normally developing children may be limited to specific tasks.
Global motion perception is often used as an index of dorsal visual stream function in neurodevelopmental studies. However, the relationship between global motion perception and visuomotor control, a primary function of the dorsal stream, is unclear. We measured global motion perception (motion coherence threshold; MCT) and performance on standardized measures of motor function in 606 4.5-year-old children born at risk of abnormal neurodevelopment. Visual acuity, stereoacuity and verbal IQ were also assessed. After adjustment for verbal IQ or both visual acuity and stereoacuity, MCT was modestly, but significantly, associated with all components of motor function with the exception of fine motor scores. In a separate analysis, stereoacuity, but not visual acuity, was significantly associated with both gross and fine motor scores. These results indicate that the development of motion perception and stereoacuity are associated with motor function in pre-school children.
Contribution of binocular vision to the performance of complex manipulation tasks in 5-13 years old visually-normal children
2016, Human Movement Science
Individual studies have shown that visuomotor coordination and aspects of binocular vision, such as stereoacuity and dynamic vergence control, continue to improve in normally developing children between birth and early teenage years. However, no study has systematically addressed the relationship between the development of binocular vision and fine manipulation skills. Thus, the aim of this cross-sectional study was to characterize performance of complex manipulation tasks during binocular and monocular viewing. Fifty-two children, between 5 and 13 years old, performed 2 manipulation tasks: peg-board and bead-threading under randomized viewing conditions. Results showed that binocular viewing was associated with a significantly greater improvement in performance on the bead-threading task in comparison to the peg-board task and the youngest children showed the greatest decrement in task performance under the monocular viewing condition when performing the bead-threading task. Thus, the role of binocular vision in performance of fine manipulation skills is both task- and age-dependent. These findings have implications for assessment of visuomotor skills in children with abnormal binocular vision, which occurs in 2–3% of otherwise typically developing children.

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: This research was supported by a grant from the National Eye Institute (EY05236).

: This study was conducted at the Retina Foundation of the Southwest.

: The authors have no conflicts of interest to disclose.

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Major articleImprovement in motor development following surgery for infantile esotropia

Purpose

Methods

Results

Conclusions

Section snippets

Participants

Presurgery Group versus Control Group

Discussion

Acknowledgment

J AAPOS

J AAPOS

J AAPOS

Ophthalmology

Ophthalmology

Ophthalmology

J Pediatr

J AAPOS

Motion VEPs, stereopsis, and bifoveal fusion in children with strabismus

Invest Ophthalmol Vis Sci

Stereoacuity of human infants

Proc Natl Acad Sci USA

Infant random dot stereoacuity cards

J Pediatr Ophthalmol Strabismus

Early motor development of blind children

J Paediatr Child Health

Major article
Improvement in motor development following surgery for infantile esotropia