Motion detection in normal infants and young patients with infantile esotropia

AbstractThe purpose of this study was to investigate asymmetries in detection of horizontal motion in normal infants and children and in patients with infantile esotropia. Motion detection thresholds (% motion signal) were measured in 75 normal infants and in 36 eyes of 27 infants with infantile esotropia (ET), using a forced-choice preferential looking paradigm with random-dot patterns. Absolute motion detection sensitivity and asymmetries in sensitivity for nasalward (N) vs. temporalward (T) directions of motion were compared in normal and patient populations, ranging in age from 1 month to 5 years. In normal infants, N and T thresholds were equivalent under 2.5 months of age, whereas a superiority for monocular detection of N motion was observed between 3.5 and 6.5 months of age. The nasalward advantage gradually diminished to symmetrical T:N performance by 8 months of age, matching that of adults. No asymmetry was observed in 15 normal infants who performed the task binocularly, hence, the asymmetry was not a leftward/rightward bias. In the youngest infantile ET patients tested, at 5 months of age, a nasalward superiority in motion detection was observed and was equivalent to that of same-age normal infants. However, unlike normals, this asymmetry persists in older patients. This greater asymmetry in infantile ET represents worse detection of T than N motion. This is the first report of an asymmetry in motion detection in normal infants across a wide age range. Initially, motion detection is normal in infants with infantile esotropia. Cumulative abnormal binocular experience in these patients may disrupt motion mechanisms

Longitudinal Development of Refractive Error in Children With Accommodative Esotropia: Onset, Amblyopia, and Anisometropia.

Purpose: We investigated longitudinal changes of refractive error in children with accommodative esotropia (ET) throughout the first 12 years of life, its dependence on age at onset of ET, and whether amblyopia or anisometropia are associated with defective emmetropization. Methods: Longitudinal refractive errors in children with accommodative ET were analyzed retrospectively. Eligibility criteria included: initial hyperopia ≥+4.00 diopters (D), initial cycloplegic refraction before 4 years, at least 3 visits, and at least one visit between 7 and 12 years. Children were classified as having infantile (N = 30; onset ≤12 months) or late-onset (N = 78; onset at 18–48 months) accommodative ET. Cycloplegic refractions culled from medical records were converted into spherical equivalent (SEQ). Results: Although the initial visit right eye SEQ was similar for the infantile and late-onset groups (+5.86 ± 1.28 and +5.67 ± 1.26 D, respectively), there were different developmental changes in refractive error. Neither group had a significant decrease in hyperopia before age 7 years, but after 7 years, the infantile group experienced a myopic shift of −0.43 D/y. The late-onset group did not experience a myopic shift at 7 to 12 years. Among amblyopic children, a slower myopic shift was observed for the amblyopic eye. Among anisometropic children, the more hyperopic eye experienced more myopic shift than the less hyperopic eye. Conclusions: Children with infantile accommodative ET experienced prolonged hyperopia followed by a myopic shift after 7 years of age, consistent with dissociation between infantile emmetropization and school age myopic shift. In contrast, children with late-onset accommodative ET had little myopic shift before or after 7 years

The critical period for surgical treatment of dense congenital unilateral cataract

-fX Purpose. Early treatment of dense congenital unilateral cataract is associated with better acuity outcomes. It is unclear whether there is a gradual worsening of prognosis with delay of treatment from the time of birth (linear model) or whether there exists an early window of time during which treatment is maximally effective, followed by declining success (bilinear model). The aim of the current study was to determine which model better describes the response to treatment. Methods. A maximum likelihood procedure that permits statistical comparison between linear and bilinear models was applied to acuity outcomes from a group of 45 children 5 to 8 years of age with a history of dense congenital unilateral cataract diagnosed at 1 to 10 days of age. Contrast sensitivity and vernier acuity data from a subset of these children were evaluated with nonparametric statistical methods. Results. The bilinear model provided a significantly better fit to the acuity outcome data. The line fitted to the initial portion of the function had a shallow slope that was not significantly different from 0.0. The intersection of the two linear functions occurred at 5.6 weeks and was followed by a steep decline in visual acuity outcomes. Contrast sensitivity and vernier outcome measures over a range of spatiotemporal conditions showed better outcomes were obtained with early treatment. Conclusions. Intervention before 6 weeks of age may minimize the effects of congenital unilateral deprivation on the developing visual system and provide for optimal rehabilitation of visual acuity. Invest Ophthalmol Vis Sci. 1996;37:1532-153

Alcohol screening and brief intervention for adolescents: The how, what and where of reducing alcohol consumption and related harm among young people

Aim: The aim of the study was to explore the evidence base on alcohol screening and brief intervention for adolescents to determine age appropriate screening tools, effective brief interventions and appropriate locations to undertake these activities. Methods: A review of existing reviews (2003-2013) and a systematic review of recent research not included in earlier reviews. Results: The CRAFFT and AUDIT tools are recommended for identification of 'at risk' adolescents. Motivational interventions delivered over one or more sessions and based in health care or educational settings are effective at reducing levels of consumption and alcohol-related harm. Conclusion: Further research to develop age appropriate screening tools needs to be undertaken. Screening and brief intervention activity should be undertaken in settings where young people are likely to present; further assessment at such venues as paediatric emergency departments, sexual health clinics and youth offending teams should be evaluated. The use of electronic (web/smart-phone based) screening and intervention shows promise and should also be the focus of future research. © The Author 2013. Published by Oxford University Press on behalf of the Medical Council on Alcohol

R375-87, and Pediatric Subunit United States Public Health Service (Bethesda, Maryland) grant MO1-RR0063

Full-field electroretinograms (ERGs) were obtained from very-low-birth-weight (VLBW) neonates to determine whether omega-3 (a>-3) fatty acids are essential for normal human retinal development. Eighty-one infants born at 30.4 (standard deviation, ±1.5) wk gestation were, within 10 d of birth, either enrolled to receive mother's milk (naturally containing both o>-6 and a>-3 essential fatty acids) or randomized to receive one of the infant formulas. Corn oil-based Formula A contained mainly linoleic acid (18:2 co-6) and was low in all co-3 fatty acids. Soy oil-based Formula B contained ample a-linolenic acid (18:3 a>-3) but no long-chain a>-3. Formula C, supplemented with both a-linolenic acid and marine oils, was comparable to human milk in long-chain co-3. Full-field ERGs were obtained in the special care nursery from infants aged 36 and 57 wk postconception. Ten healthy preterm infants born at 35 wk gestation were tested at 36 wk postconception. Significant differences were found among groups in rod ERG function. Post hoc comparisons showed that infants fed Formula A had significantly higher rod thresholds than infants receiving long-chain co-3 (human milk, Formula C, and intrauterine). Infants receiving Formula B had intermediate thresholds that were significantly higher than those of infants receiving intrauterine nutrition. Analysis of the leading edge of the a-wave showed that b-wave differences originated at the photoreceptor level. Differences were not present in infants at 57 wk postconception. No significant differences among groups were found in cone b-waves at 36 or 57 wk postconception. Oscillatory potentials had significantly longer implicit times at 57 wk postconception in infants fed Formula A than in infants receiving human milk. These findings suggest that retinal function varies with the dietary supply of co-3 fatty acids in VLBW infants. Invest Ophthalmol Vis Sci 33: [2365][2366][2367][2368][2369][2370][2371][2372][2373][2374][2375][2376]1992 Linoleic acid (18:2 00-6) and a-linolenic acid (18:3 a>-3) are considered essential fatty acids (EFAs) for humans because of our inability to synthesize them and the resulting deficiency syndromes when they are removed from the diet

R375-87, and Pediatric Subunit United States Public Health Service (Bethesda, Maryland) grant MO1-RR0063

Full-field electroretinograms (ERGs) were obtained from very-low-birth-weight (VLBW) neonates to determine whether omega-3 (a>-3) fatty acids are essential for normal human retinal development. Eighty-one infants born at 30.4 (standard deviation, ±1.5) wk gestation were, within 10 d of birth, either enrolled to receive mother's milk (naturally containing both o>-6 and a>-3 essential fatty acids) or randomized to receive one of the infant formulas. Corn oil-based Formula A contained mainly linoleic acid (18:2 co-6) and was low in all co-3 fatty acids. Soy oil-based Formula B contained ample a-linolenic acid (18:3 a>-3) but no long-chain a>-3. Formula C, supplemented with both a-linolenic acid and marine oils, was comparable to human milk in long-chain co-3. Full-field ERGs were obtained in the special care nursery from infants aged 36 and 57 wk postconception. Ten healthy preterm infants born at 35 wk gestation were tested at 36 wk postconception. Significant differences were found among groups in rod ERG function. Post hoc comparisons showed that infants fed Formula A had significantly higher rod thresholds than infants receiving long-chain co-3 (human milk, Formula C, and intrauterine). Infants receiving Formula B had intermediate thresholds that were significantly higher than those of infants receiving intrauterine nutrition. Analysis of the leading edge of the a-wave showed that b-wave differences originated at the photoreceptor level. Differences were not present in infants at 57 wk postconception. No significant differences among groups were found in cone b-waves at 36 or 57 wk postconception. Oscillatory potentials had significantly longer implicit times at 57 wk postconception in infants fed Formula A than in infants receiving human milk. These findings suggest that retinal function varies with the dietary supply of co-3 fatty acids in VLBW infants. Invest Ophthalmol Vis Sci 33: [2365][2366][2367][2368][2369][2370][2371][2372][2373][2374][2375][2376]1992 Linoleic acid (18:2 00-6) and a-linolenic acid (18:3 a>-3) are considered essential fatty acids (EFAs) for humans because of our inability to synthesize them and the resulting deficiency syndromes when they are removed from the diet