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Acuity Development in Infantile Nystagmus

¹From the Division of Ophthalmology, Roger H. Johnson Clinical Vision Lab, Children's Hospital, Seattle, Washington; and the ²Division of Ophthalmology, University of Washington, Seattle, Washington.

PURPOSE. To compare development of acuity in patients with isolated infantile nystagmus and infantile nystagmus associated with a visual sensory defect.

METHODS. Visual acuities in 57 children (1 month to 4 years of age) with infantile nystagmus were assessed by using Teller acuity cards oriented vertically during binocular viewing. Twenty-two had isolated infantile nystagmus, 21 had albinism, 7 had aniridia, and 7 had mild or moderate bilateral optic nerve hypoplasia (BONH). Longitudinal acuity was measured in 40 of these patients (mean 1.8, 2.3, 3.1, and 3.3, measurements per patient group, respectively). The rate of acuity development across the study groups was quantified by linear regression of log acuity versus log age and compared to published normative data.

RESULTS. The rate of acuity development was similar across all groups and paralleled the normative data. The slope of log grating acuity versus log age (±SEM) was normal, 0.73; isolated infantile nystagmus, 0.80 ± 0.11; albinism, 0.80 ± 0.11; aniridia, 0.87 ± 0.16; and BONH, 0.79 ± 0.18. The slopes were not significantly different (ANCOVA, F_4,142 = 0.21, P = 0.93). Compared with published binocular normative data, mean acuity adjusted for age was reduced by 1.2 octaves in isolated infantile nystagmus and by 1.7 to 2.5 octaves in nystagmus with associated sensory defect.

CONCLUSIONS. The rate of acuity development in infantile nystagmus is largely independent of the gaze-holding instability or an associated visual sensory defect. Reduction of mean acuity in albinism, aniridia, and BONH is due to the visual sensory defect and exceeds the acuity reduction observed in isolated infantile nystagmus.