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

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

Risk factors for accommodative esotropia among hypermetropic children

PURPOSE. Identification of risk factors for accommodative esotropia may help to determine which children with hyperopia may benefit from early spectacle correction or preventive therapy. METHODS. Participants in the family history study were 95 consecutive patients, aged 18 to 60 months, with accommodative esotropia. Participants in the binocular sensory function study were a subgroup of 41 children enrolled in the family history study within 1 month of onset, while the esodeviation was still intermittent. Participants in the hypermetropia study were 345 consecutive patients, ages 12 months to 8 years, with refractive error of ϩ2.00 D or greater and no esodeviation before age 12 months. RESULTS. In the family history study, 23% of children with accommodative esotropia had an affected first-degree relative, and 91% had at least one affected relative. In the binocular sensory function study, random-dot stereoacuity was abnormal in 41% of children, whereas an abnormal motion VEP, Worth 4-dot, or positive 4-PD base-out prism responses were present in 4% or less of the children. In the hypermetropia study, patients with a mean spherical equivalent of Ͻ ϩ3.00 D and significant anisometropia had a 7.8-fold increased risk for accommodative esotropia over nonanisometropic patients. CONCLUSIONS. A positive family history, subnormal random-dot stereopsis, and hypermetropic anisometropia each pose a significant risk for the development of accommodative esotropia. Assessment of these risk factors in conjunction with refractive screening should help to identify those children who are most likely to benefit from early spectacle correction or preventive treatment. (Invest Ophthalmol Vis Sci. 2005;46:526 -529

Visual Psychophysics and Physiological Optics Development of Refractive Error in Individual Children With Regressed Retinopathy of Prematurity

PURPOSE. We investigated longitudinally the refraction development in children with regressed retinopathy of prematurity (ROP), including those with and those without a history of peripheral retinal laser photocoagulation. METHODS. Longitudinal (0-7 years) cycloplegic refraction data were collected prospectively for two groups of preterm children: severe ROP group included those with regressed ROP following bilateral panretinal laser photocoagulation (n ¼ 37; median gestational age [GA] ¼ 25.2; range, 22.7-27.9 weeks) and mild/no ROP group included those with spontaneously regressed ROP or no ROP (n ¼ 27; median GA ¼ 27.1; range, 23.1-32.0 weeks). Analyses were based on spherical equivalent (SEQ), anisometropia, astigmatism, and age (corrected for gestation). RESULTS. The prevalence, magnitude, and rate of myopic progression all were significantly higher in the severe ROP group than in the mild/no ROP group. Longitudinal SEQ in the severe ROP group were best fit with a bilinear model. Before 1.3 years old, the rate of myopic shift was À4.7 diopters (D)/y; after 1.3 years, the rate slowed to À0.15 D/y. Longitudinal SEQ in the mild/no ROP group was best fit with a linear model, with a rate of À0.004 D/y. Anisometropia in the severe ROP group increased approximately three times faster than in the mild/no ROP group. In the severe ROP group, with-the-rule astigmatism increased significantly with age. CONCLUSIONS. The severe ROP group progressed rapidly toward myopia, particularly during the first 1.3 years; anisometropia and astigmatism also increased with age. The mild/no ROP group showed little change in refraction. Infants treated with laser photocoagulation for severe ROP should be monitored with periodic cycloplegic refractions and provided with early optical correction. Keywords: myopia, refractive error development, retinopathy of prematurity, laser photocoagulation R etinopathy of prematurity (ROP) is one of the leading causes of childhood visual impairment and blindness in the United States. The prevalence of myopia has been reported to vary with severity of ROP, ranging from 0% to 16% for preterm infants with no ROP 1-3 to 21% to 100% for children whose severe ROP was laser-treated. 1-4 The prevalence of myopia in children with severe ROP is astonishingly high, especially in those who received peripheral laser-photocoagulation. 7,8 A longitudinal study of 62 preterm children with mild/no ROP reported that 24% had myopia during early childhood and only 11% had high myopia. 9 This study will focus on comparing longitudinal changes in refractive error of individual preterm children who had severe ROP (treated with laser-photocoagulation) and those with mild/no ROP. To our knowledge, previous studies have not offered a model to predict an individual's development of refractive error because they did not track individual myopic progression. As a result, gaps remain in our understanding of refractive error development in individual children with ROP. Furthermore, it is well-known that there is a high prevalence (6-fold higher tha

The Effectiveness of Alcohol Screening and Brief Intervention in Emergency Departments: A Multicentre Pragmatic Cluster Randomized Controlled Trial

BACKGROUND: Alcohol misuse is common in people attending emergency departments (EDs) and there is some evidence of efficacy of alcohol screening and brief interventions (SBI). This study investigated the effectiveness of SBI approaches of different intensities delivered by ED staff in nine typical EDs in England: the SIPS ED trial. METHODS AND FINDINGS: Pragmatic multicentre cluster randomized controlled trial of SBI for hazardous and harmful drinkers presenting to ED. Nine EDs were randomized to three conditions: a patient information leaflet (PIL), 5 minutes of brief advice (BA), and referral to an alcohol health worker who provided 20 minutes of brief lifestyle counseling (BLC). The primary outcome measure was the Alcohol Use Disorders Identification Test (AUDIT) status at 6 months. Of 5899 patients aged 18 or more presenting to EDs, 3737 (63·3%) were eligible to participate and 1497 (40·1%) screened positive for hazardous or harmful drinking, of whom 1204 (80·4%) gave consent to participate in the trial. Follow up rates were 72% (n?=?863) at six, and 67% (n?=?810) at 12 months. There was no evidence of any differences between intervention conditions for AUDIT status or any other outcome measures at months 6 or 12 in an intention to treat analysis. At month 6, compared to the PIL group, the odds ratio of being AUDIT negative for brief advice was 1·103 (95% CI 0·328 to 3·715). The odds ratio comparing BLC to PIL was 1·247 (95% CI 0·315 to 4·939). A per protocol analysis confirmed these findings. CONCLUSIONS: SBI is difficult to implement in typical EDs. The results do not support widespread implementation of alcohol SBI in ED beyond screening followed by simple clinical feedback and alcohol information, which is likely to be easier and less expensive to implement than more complex interventions