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Rakshit A, Schmid KL, Webber AL. Fine visuomotor skills in amblyopia: a systematic review and meta-analysis. Br J Ophthalmol 2024; 108:633-645. [PMID: 37669851 DOI: 10.1136/bjo-2022-322624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/25/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Amblyopia is characterised by reduced visual acuity, poor binocular sensory fusion, and impaired or absent stereoacuity. Understanding the extent to which amblyopia affects everyday task performance is important to quantifying the disease burden of amblyopia and can assist clinicians to understand patients' likely functional capability. METHODS A systematic literature search identified published studies comparing fine visuomotor performance in either children or adults with amblyopia and those with normal binocular vision. The included studies (22 studies involving 835 amblyopes and 561 controls) reported results of self-perception patient reported outcome measures, tests of motor proficiency and video recorded reaching and grasping. The outcomes of 17 studies were grouped into four meta-analyses, with pooled results reported as standardised mean difference (SMD) with corresponding 95% CI. RESULTS Regardless of the cause of amblyopia (anisometropia, strabismus, mixed, deprivation), significant reduction in self-perception of physical competence and athletic competence (SMD=-0.74, 95% CI -1.23 to -0.25, p=0.003); fine motor skills scores (SMD=-0.86, 95% CI -1.27 to -0.45, p<0.0001); speed of visually guided reaching and grasping movements (SMD=0.86, 95% CI 0.65 to 1.08, p<0.00001); and precision of temporal eye-hand coordination (SMD=0.75, 95% CI 0.26 to 1.25, p=0.003) occurred in amblyopes compared with those with normal visual development. CONCLUSION Reports of the impact of amblyopia on fine motor skills performance find poorer outcomes in participants with amblyopia compared with those with normal vision development. Consistency in the outcome measure used to assess the functional impact of amblyopia would be valuable for future studies.
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Affiliation(s)
- Archayeeta Rakshit
- School of Optometry and Vision Science, Centre for Vision and Eye Research, Faculty of Health, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, Queensland, Australia
| | - Katrina L Schmid
- School of Optometry and Vision Science, Centre for Vision and Eye Research, Faculty of Health, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, Queensland, Australia
| | - Ann L Webber
- School of Optometry and Vision Science, Centre for Vision and Eye Research, Faculty of Health, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, Brisbane, Queensland, Australia
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2
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Niechwiej-Szwedo E, Brin TA, Thompson B, Christian LWT. Kinematic Assessment of Fine Motor Skills in Children: Comparison of a Kinematic Approach and a Standardized Test. Vision (Basel) 2024; 8:6. [PMID: 38391087 PMCID: PMC10885072 DOI: 10.3390/vision8010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
Deficits in fine motor skills have been reported in some children with neurodevelopmental disorders such as amblyopia or strabismus. Therefore, monitoring the development of motor skills and any potential improvement due to therapy is an important clinical goal. The aim of this study was to test the feasibility of performing a kinematic assessment within an optometric setting using inexpensive, portable, off-the-shelf equipment. The study also assessed whether kinematic data could enhance the information provided by a routine motor function screening test (the Movement Assessment Battery for Children, MABC). Using the MABC-2, upper limb dexterity was measured in a cohort of 47 typically developing children (7-15 years old), and the Leap motion capture system was used to record hand kinematics while children performed a bead-threading task. Two children with a history of amblyopia were also tested to explore the utility of a kinematic assessment in a clinical population. For the typically developing children, visual acuity and stereoacuity were within the normal range; however, the average standardized MABC-2 scores were lower than published norms. Comparing MABC-2 and kinematic measures in the two children with amblyopia revealed that both assessments provide convergent results and revealed deficits in fine motor control. In conclusion, kinematic assessment can augment standardized tests of fine motor skills in an optometric setting and may be useful for measuring visuomotor function and monitoring treatment outcomes in children with binocular vision anomalies.
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Affiliation(s)
- Ewa Niechwiej-Szwedo
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Taylor A Brin
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
- Centre for Eye and Vision Research, 17W Science Park, Hong Kong
- Liggins Institute, University of Auckland, Auckland 1010, New Zealand
| | - Lisa W T Christian
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Zhou Z, Zhu Y, Luo R, Chen K, Li X, Guo X, Yu X, Huang W, Zhuo Y. The associations of self-perception, movement competence, and clinical features of young school-aged children with glaucoma. Eur J Pediatr 2024; 183:885-895. [PMID: 37864600 DOI: 10.1007/s00431-023-05262-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/22/2023] [Accepted: 10/05/2023] [Indexed: 10/23/2023]
Abstract
The purpose of the study was to determine the associations of self-perception, motor skills, and clinical features of young school-age children with glaucoma (CG). This is a cross-sectional observational study. Children from preschool to second grade, including CG (N = 19), children with amblyopia (CA, N = 28), and controls (N = 32), completed the Manual Dexterity and Aiming and Catching Scales of the Movement Assessment Battery for Children-2nd edition (MABC-2), including Manual Dexterity, Aiming and Catching, and Balance. CG, CA, and their parent completed the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children, respectively, assessing the child's cognitive competence, peer acceptance, physical competence, and maternal acceptance. The Kruskal-Wallis H test and Bonferroni post hoc test compared motor skills among groups. Spearman's correlation analysis evaluated the correlations between motor skills, self-perception, and clinical features. The CG reported lower peer acceptance than CA (P = 0.040), and the parents of CG reported lower cognitive competence than CG reported (P = 0.046). Compared with controls, CG had worse performance of Aiming and Catching, and Balance (P = 0.018 and P = 0.001), and CA had worse performance of Balance (P = 0.009). The motor skills were comparable between CG and CA. For CG, older age correlated with worse competence of Aiming and Catching (r = - 0.620, P = 0.005), better best-corrected visual acuity of better-seeing eye correlated with higher competence of Manual Dexterity and Balance (r = - 0.494, P = 0.032, and r = - 0.516, P = 0.024), and longer duration of glaucoma correlated with worse competence of Manual Dexterity (r = - 0.487, P = 0.034). CONCLUSION Glaucoma and amblyopia have significant negative impacts on children's daily motor skills. The acuity of a better-seeing eye is an important factor influencing motor movement. TRIAL REGISTRATION ClinicalTrials.gov identifier, ChiCTR2100050415. WHAT IS KNOWN • The state of mental health in early childhood influences the development of their future personality and physical development. The prognosis and management of glaucoma may seriously impair the mental health development of the affected children. However, the exploration of psychological aspects and motor movement of childhood glaucoma was limited. WHAT IS NEW • Children with glaucoma have impaired motor skills and self-perception development, especially in terms of peer socialization.
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Affiliation(s)
- Zhuandi Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 Xianlie S Rd, Guangzhou, 510060, China
| | - Yingting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 Xianlie S Rd, Guangzhou, 510060, China
| | - Ruiyu Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 Xianlie S Rd, Guangzhou, 510060, China
| | - Kezhe Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 Xianlie S Rd, Guangzhou, 510060, China
| | - Xinyan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 Xianlie S Rd, Guangzhou, 510060, China
| | - Xiaoxin Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 Xianlie S Rd, Guangzhou, 510060, China
| | - Xinping Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 Xianlie S Rd, Guangzhou, 510060, China
| | - Wenmin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 Xianlie S Rd, Guangzhou, 510060, China.
| | - Yehong Zhuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, 54 Xianlie S Rd, Guangzhou, 510060, China.
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Ahmad Z, Kelly KR, Freud E. Reduced perception-action dissociation in children with amblyopia. Neuropsychologia 2023; 191:108738. [PMID: 38007150 DOI: 10.1016/j.neuropsychologia.2023.108738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/08/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
The functional distinction between vision-for-perception and vision-for-action is a key aspect of understanding the primate visual system. While this dissociation has been well-established in adulthood, its development and dependence on typical visual experience remain unclear. To address these questions, we examined two groups of children: typically developed children and those with amblyopia, who presumably have a sub-optimal visual experience. The Ponzo illusion, known to impact perception but not visuomotor behaviors across age groups, was employed to assess the extent of dissociation. Participants engaged in two tasks involving the Ponzo illusion: a grasping task (vision-for-action) and a manual estimation task (vision-for-perception), with objects placed on the "close" and "far" surfaces of the illusion. Typically developed children displayed grasping movements that were unaffected by the illusion, as their grasping apertures were scaled based on object size, independent of its location. In contrast, children with amblyopia exhibited a clear susceptibility to the illusion, showing larger apertures for objects placed on the 'far' surface of the illusion, and smaller apertures for objects placed on the 'close' surface. Interestingly, both groups of children demonstrated similar susceptibility to the illusion during the perceptual task, with objects placed on the far surface being perceived as longer compared to objects placed on the close surface. These findings shed light on the impact of atypical visual development on the emergence of the dissociation between perception and action, highlighting the crucial role of typical visual experience in establishing this distinction.
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Affiliation(s)
- Zoha Ahmad
- Department of Biology, York University, Canada; The Centre for Vision Research, York University, Canada.
| | - Krista R Kelly
- School of Optometry and Vision Science, University of Waterloo, Canada; Retina Foundation of the Southwest, Dallas, USA
| | - Erez Freud
- The Centre for Vision Research, York University, Canada; Department of Psychology, York University, Canada
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Nowik M, Perna F, Dahlmann-Noor A, Stern J, Malkowski JP, Weisberger A, Webber A. Amblyopia-A novel virtual round table to explore the caregiver perspective. Ophthalmic Physiol Opt 2023; 43:1571-1580. [PMID: 37515472 DOI: 10.1111/opo.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/08/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE A survey aimed to capture the caregiver's perspective on the impact of amblyopia and its treatment on the child and family, as well as caregivers' views on the design and feasibility of clinical trials investigating dichoptic binocular therapies for amblyopia. METHODS Parents of amblyopic children, patient advocates and healthcare professionals took part in a moderated, structured discussion on a novel virtual advisory-board platform. RESULTS Seven parents of children with amblyopia, two patient organisation representatives, one ophthalmologist and one optometrist participated in the survey. A total of 645 posts were entered on the platform over a 14-day period in September 2021. There was widespread agreement that the management of amblyopia poses more of a burden on the child and family than the condition itself, with treatment burden accentuated when treatment is unsuccessful. Parents expressed uncertainty and frustration in relation to the duration of patching, success of patching and alternative treatment options, and felt there was inadequate readily available, easy-to-understand information on the condition. Parents reported that a new treatment for amblyopia, such as dichoptic binocular therapy using video games, should be safe, non-invasive and engaging compared with an eye patch. Treating at home, potentially for a shorter treatment duration, and with an entertaining game were the main reasons parents would join a clinical study with this type of novel therapy. However, due to a limited critical period treatment window, parents would feel more comfortable joining a clinical trial if traditional therapies were offered in conjunction with those under investigation. CONCLUSION Patient perspectives and the role of caregivers in the acceptance of any interventional treatments are increasingly recognised. Understanding how amblyopia and its treatment impacts a child and family should be an important premise to guide therapy and evaluate treatment value, both in clinical trials and in routine medical practice.
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Affiliation(s)
| | | | | | - Jude Stern
- c/o International Agency for the Prevention of Blindness (IAPB), Sydney, New South Wales, Australia
| | | | | | - Ann Webber
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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6
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Verghese P. The utility of peripheral stereopsis. Front Neurosci 2023; 17:1217993. [PMID: 37795187 PMCID: PMC10545962 DOI: 10.3389/fnins.2023.1217993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/14/2023] [Indexed: 10/06/2023] Open
Abstract
This perspective article makes the case for evaluating and training peripheral stereopsis, particularly when the central visual field is compromised in one or both eyes. Examples of clinical conditions that preferentially affect the central visual field include macular degeneration, which affects the central macular region in one or both eyes, and amblyopia where the central field is often affected in one eye, but the peripheral field is largely intact. While binocular acuity may be preserved when the monocular central field of one eye is affected, fine stereopsis is compromised because it requires intact vision in corresponding locations in the two eyes. Even in these clinical conditions, recent studies that map stereoacuity at locations across the visual field demonstrate that the periphery supports coarse stereopsis, and that training efforts to use residual stereopsis may have greater benefit if they take this finding into account.
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Affiliation(s)
- Preeti Verghese
- Smith-Kettlewell Eye Research Institute, San Francisco, CA, United States
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7
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Horwood A, Heijnsdijk E, Kik J, Sloot F, Carlton J, Griffiths HJ, Simonsz HJ. A population-level post-screening treatment cost framework to help inform vision screening choices for children under the age of seven. Strabismus 2023; 31:220-235. [PMID: 37870065 DOI: 10.1080/09273972.2023.2268128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
PURPOSE/BACKGROUND Visual acuity (VA) screening in children primarily detects low VA and amblyopia between 3 and 6 years of age. Photoscreening is a low-cost, lower-expertise alternative which can be carried out on younger children and looks instead for refractive amblyopia risk factors so that early glasses may prevent or mitigate the conditions. The long-term benefits and costs of providing many children with glasses in an attempt to avoid development of amblyopia for some of them needs clarification. This paper presents a framework for modeling potential post-referral costs of different screening models once referred children reach specialist services. METHODS The EUSCREEN Screening Cost-Effectiveness Model was used together with published literature to estimate referral rates and case mix of referrals from different screening modalities (photoscreening and VA screening at 2, 3-4 years and 4-5 years). UK 2019-20 published National Health Service (NHS) costings were used across all scenarios to model the comparative post-referral costs to the point of discharge from specialist services. Potential costs were compared between a) orthoptist, b) state funded ophthalmologist and c) private ophthalmologist care. RESULTS Earlier VA screening and photoscreening yield higher numbers of referrals because of lower sensitivity and specificity for disease, and a different case mix, compared to later VA screening. Photoscreening referrals are a mixture of reduced VA caused by amblyopia and refractive error, and children with amblyopia risk factors, most of which are treated with glasses. Costs relate mainly to the secondary care providers and the number of visits per child. Treatment by an ophthalmologist of a referral at 2 years of age can be more than x10 more expensive than an orthoptist service receiving referrals at 5 years, but outcomes can still be good from referrals aged 5. CONCLUSIONS All children should be screened for amblyopia and low vision before the age of 6. Very early detection of amblyopia refractive risk factors may prevent or mitigate amblyopia for some affected children, but population-level outcomes from a single high-quality VA screening at 4-5 years can also be very good. Total patient-journey costs incurred by earlier detection and treatment are much higher than if screening is carried out later because younger children need more professional input before discharge, so early screening is less cost-effective in the long term. Population coverage, local healthcare models, local case-mix, public health awareness, training, data monitoring and audit are critical factors to consider when planning, evaluating, or changing any screening programme.
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Affiliation(s)
- Anna Horwood
- Department of Psychology, University of Reading, Reading, UK
| | - Eveline Heijnsdijk
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jan Kik
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Frea Sloot
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | | | - Huibert J Simonsz
- Department of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
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Birch EE, Kelly KR. Amblyopia and the whole child. Prog Retin Eye Res 2023; 93:101168. [PMID: 36736071 PMCID: PMC9998377 DOI: 10.1016/j.preteyeres.2023.101168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 02/04/2023]
Abstract
Amblyopia is a disorder of neurodevelopment that occurs when there is discordant binocular visual experience during the first years of life. While treatments are effective in improving visual acuity, there are significant individual differences in response to treatment that cannot be attributed solely to difference in adherence. In this considerable variability in response to treatment, we argue that treatment outcomes might be optimized by utilizing deep phenotyping of amblyopic deficits to guide alternative treatment choices. In addition, an understanding of the broader knock-on effects of amblyopia on developing visually-guided skills, self-perception, and quality of life will facilitate a whole person healthcare approach to amblyopia.
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Affiliation(s)
- Eileen E Birch
- Pediatric Vision Laboratory, Retina Foundation of the Southwest, 9600 North Central Expressway #200, Dallas, TX, 75225, USA; Department of Ophthalmology, University of Texas Southwestern Medical Center, 5303 Harry Hines Boulevard, Dallas, TX, 75390, USA.
| | - Krista R Kelly
- Department of Ophthalmology, University of Texas Southwestern Medical Center, 5303 Harry Hines Boulevard, Dallas, TX, 75390, USA; Vision and Neurodevelopment Laboratory, Retina Foundation of the Southwest, 9600 North Central Expressway #200, Dallas, TX, 75225, USA.
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9
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Birch EE, Morale SE, Jost RM, Cheng-Patel CS, Kelly KR. Binocular amblyopia treatment improves manual dexterity. J AAPOS 2023; 27:18.e1-18.e6. [PMID: 36567045 PMCID: PMC9974856 DOI: 10.1016/j.jaapos.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine whether deficits in manual dexterity in children with amblyopia improve after binocular amblyopia treatment and whether improvements are related to age at treatment, baseline sensory status, or amount of improvement in sensory status with treatment. METHODS Manual dexterity (Movement Assessment Battery for Children-2), visual acuity, fusion, suppression, and stereoacuity were measured at baseline and after 4-8 weeks of binocular amblyopia in 134 children with amblyopia, including 75 children in the "younger group" (aged 3 to <7 years) and 59 in the "older group" (aged 7-10 years), and in 40 age-similar control children. RESULTS Baseline manual dexterity standard scores of amblyopic children were significantly below those of controls in both the younger (8.81 ± 0.33 vs 11.80 ± 0.60 [P < 0.0001]) and older groups (7.19 ± 0.34 vs 9.75 ± 0.57 [P = 0.00013]). After 4-8 weeks of binocular amblyopia treatment, the younger group standard score improved to 9.85 ± 0.35 and the older group improved to 8.08 ± 0.39, but both groups remained significantly lower than controls (P = 0.03 and P = 0.01, resp.). Improvement in manual dexterity standard score was not associated with any baseline factors but was weakly correlated with the amount of visual acuity improvement (rs = 0.26; 95% CI, 0.09-0.41) CONCLUSIONS: Manual dexterity impairments are common among children with amblyopia. In our study cohort, binocular amblyopia treatment improved visual acuity and manual dexterity.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | | | - Reed M Jost
- Retina Foundation of the Southwest, Dallas, Texas
| | | | - Krista R Kelly
- Retina Foundation of the Southwest, Dallas, Texas; Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas
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10
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Niechwiej-Szwedo E, Colpa L, Wong A. The role of binocular vision in the control and development of visually guided upper limb movements. Philos Trans R Soc Lond B Biol Sci 2023; 378:20210461. [PMID: 36511416 PMCID: PMC9745875 DOI: 10.1098/rstb.2021.0461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/16/2022] [Indexed: 12/15/2022] Open
Abstract
Vision provides a key sensory input for the performance of fine motor skills, which are fundamentally important to daily life activities, as well as skilled occupational and recreational performance. Binocular visual function is a crucial aspect of vision that requires the ability to combine inputs from both eyes into a unified percept. Summation and fusion are two aspects of binocular processing associated with performance advantages, including more efficient visuomotor control of upper limb movements. This paper uses the multiple processes model of limb control to explore how binocular viewing could facilitate the planning and execution of prehension movements in adults and typically developing children. Insight into the contribution of binocularity to visuomotor control also comes from examining motor performance in individuals with amblyopia, a condition characterized by reduced visual acuity and poor binocular function. Overall, research in this field has advanced our understanding of the role of binocular vision in the development and performance of visuomotor skills, the first step towards developing assessment tools and targeted rehabilitation for children with neurodevelopment disorders at risk of poor visuomotor outcomes. This article is part of a discussion meeting issue 'New approaches to 3D vision'.
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Affiliation(s)
- Ewa Niechwiej-Szwedo
- Kinesiology and Health Sciences, University of Waterloo, 200 University Avenue, Waterloo, ON, Canada N2L 3G1
| | - Linda Colpa
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8
| | - Agnes Wong
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8
- University of Toronto, 27 King's College Circle, Toronto, ON, Canada M5S 1A4
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11
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Kelly KR, Norouzi DM, Nouredanesh M, Jost RM, Cheng-Patel CS, Beauchamp CL, Dao LM, Luu BA, Stager DR, Tung JY, Niechwiej-Szwedo E. Temporal Eye–Hand Coordination During Visually Guided Reaching in 7- to 12-Year-Old Children With Strabismus. Invest Ophthalmol Vis Sci 2022; 63:10. [DOI: 10.1167/iovs.63.12.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Krista R. Kelly
- Retina Foundation of the Southwest, Dallas, TX, United States
- Department of Ophthalmology, UT Southwestern Medical Center, Dallas, TX, United States
| | | | - Mina Nouredanesh
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Reed M. Jost
- Retina Foundation of the Southwest, Dallas, TX, United States
| | | | | | - Lori M. Dao
- ABC Eyes Pediatric Ophthalmology, PA, Dallas, TX, United States
| | - Becky A. Luu
- Pediatric Ophthalmology & Adult Strabismus, PA, Plano, TX, United States
| | - David R. Stager
- Pediatric Ophthalmology & Adult Strabismus, PA, Plano, TX, United States
| | - James Y. Tung
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario, Canada
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12
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Sánchez‐González MC, Palomo‐Carrión R, De‐Hita‐Cantalejo C, Romero‐Galisteo RP, Gutiérrez‐Sánchez E, Pinero‐Pinto E. Visual system and motor development in children: a systematic review. Acta Ophthalmol 2022; 100:e1356-e1369. [PMID: 35118800 PMCID: PMC9790241 DOI: 10.1111/aos.15111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/26/2021] [Accepted: 01/20/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The aim of this study was to review the available scientific literature on the possible relationship between the visual system and motor development in children. METHODS This study was performed according to the Preferred Reporting Items for Systematic Reviews (PRISMA) statement recommendations. The review protocol is available in PROSPERO (CRD42021245341). Four different databases, namely Scopus, PubMed, CINAHL and Web of Science, were assessed from April 2005 to February 2021. To determine the quality of the articles, we used the Critical Appraisal Skills Programme (CASP) Quality Appraisal Scale, and a protocol was followed to define the levels of evidence on the basis of the Centre for Evidence-Based Medicine Levels of Evidence. The search strategy included terms describing motor development in children and adolescents with visual disorders. RESULTS Among the identified studies, 23 were included in the study. All selected articles examined the relationship between the visual system and development in children. The quality of most of the studies was moderate-high, and they were between evidence levels 2 and 4. CONCLUSIONS Our systematic review revealed that all included studies established a relationship between the visual system and development in children. However, the methods for measuring the visual system and motor skills lacked uniformity.
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Affiliation(s)
| | - Rocío Palomo‐Carrión
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of PhysiotherapyUniversity of Castilla‐La ManchaCiudad RealSpain
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Birch EE, Jost RM, Hudgins LA, Morale SE, Donohoe M, Kelly KR. Dichoptic and Monocular Visual Acuity in Amblyopia. Am J Ophthalmol 2022; 242:209-214. [PMID: 35738394 PMCID: PMC9847578 DOI: 10.1016/j.ajo.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Standard-of-care assessment for children with amblyopia includes measuring amblyopic eye best-corrected visual acuity (AE BCVA) with the fellow eye occluded. By definition, this abolishes the interocular suppression fundamental to amblyopia. Thus, measured AE BCVA may not accurately represent that eye's contribution to natural binocular viewing. We compared dichoptic and monocular AE BCVA and examined whether any differences were associated with eye-hand coordination or reading speed. DESIGN Cross-sectional study. METHODS Dichoptic and monocular AE BCVA of children aged 6-12 years (42 with amblyopia, 24 with recovered normal AE BCVA, 30 control) were measured. Stereoacuity, suppression, eye-hand coordination, and reading speed were also assessed. RESULTS Overall, 81% of amblyopic children had worse dichoptic than monocular AE BCVA (mean difference=0.15±0.11 logMAR; P < .0001), and 71% of children with recovered normal AE BCVA had worse dichoptic than monocular AE BCVA (mean difference = 0.20±0.17 logMAR, P < .0001). Controls had no significant difference. The difference between dichoptic and monocular AE BCVA was correlated with performance in standardized aiming/catching (r = -0.48, 95% CI -0.72, -0.14) and manual dexterity tasks (r = -0.37, 95% CI -0.62, -0.06), and with reading speed (r = -0.38, 95% CI -0.65, -0.03). CONCLUSIONS Dichoptic AE BCVA deficits were worse than monocular AE BCVA deficits and were associated with reduced stereoacuity and suppression, consistent with the hypothesis that binocular dysfunction plays a role. Further, impaired eye-hand coordination and slow reading were associated with dichoptic, but not monocular, AE BCVA. Some children with amblyopia may benefit from extra time for school tasks requiring eye-hand coordination or reading.
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Affiliation(s)
- Eileen E Birch
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.).
| | - Reed M Jost
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
| | - Lindsey A Hudgins
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
| | - Sarah E Morale
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
| | - Matthew Donohoe
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
| | - Krista R Kelly
- From the Retina Foundation of the Southwest, Dallas, TX (E.E.B., R.M.J., L.A.H., S.E.M., M.D., K.R.K.), Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA (E.E.B., K.R.K.)
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14
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Brin TA, Xu Z, Zhou Y, Feng L, Li J, Thompson B. Amblyopia is associated with impaired balance in 3–6-year-old children in China. Front Neurosci 2022; 16:993826. [PMID: 36213736 PMCID: PMC9544236 DOI: 10.3389/fnins.2022.993826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/05/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose School-age children in China have more advanced motor development than their North American counterparts. This is likely due to cultural differences in children’s regular motor activities. It is unknown whether the motor function impairments associated with binocular visual disorders (BVDs) such as amblyopia in children raised in North America exist for children raised in China. Design Prospective case-control study. Methods A major tertiary eye hospital in China tested children aged 3 to <7 (n = 63) belonging to three groups: anisometropic or strabismic amblyopia (n = 22), anisometropia or strabismus without amblyopia (n = 20), or controls (n = 21). The main outcome measure was motor function scores (Movement Assessment Battery for Children 2nd edition). Results Balance scores varied significantly across groups (F2,61 = 4.2, p = 0.02) with the amblyopia group (mean ± SD: 12.5 ± 3.0) exhibiting significantly poorer scores than controls (14.8 ± 2.3). The no-amblyopia BVD group (12.8 ± 3.1) did not differ significantly from the other groups. Manual dexterity, catching and throwing and total scores did not vary significantly across the three groups. A separate pre-planned comparison of only the amblyopia and control groups revealed significantly poorer total motor scores in the amblyopia group (10.1 ± 3.2) vs. controls (12 ± 2.4). A linear regression model was unable to significantly predict associations between total motor score and binocular function score (standardized β = −0.09, 95%, p = 0.7), amblyopia etiology (standardized β = 0.14, 95%, p = 0.4), or inter-ocular acuity difference (standardized β = −0.18, 95%, p = 0.4), in the amblyopia group. Conclusion Amblyopia is associated with motor function impairment in children raised in China. Motor deficits that may impact everyday activities have been observed in patients with amblyopia across multiple cultures.
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Affiliation(s)
- Taylor A. Brin
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Zixuan Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yusong Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lei Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jinrong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Jinrong Li,
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
- Center for Eye and Vision Research Limited, Hong Kong, Hong Kong SAR, China
- Liggins Institute, University of Auckland, Auckland, New Zealand
- *Correspondence: Benjamin Thompson,
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15
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Fang C, Wu Y, peng T, Wang C, Lou J, Xu M, Bao J, Chen C, Yu X. Reading speed in school-age children with intermittent exotropia. Sci Rep 2022; 12:9423. [PMID: 35676393 PMCID: PMC9177830 DOI: 10.1038/s41598-022-13293-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
Reading speed in intermittent exotropia (IXT) children has been minimally examined. This study assessed reading speed in school-age children with IXT and determined clinical characteristics of IXT that impacted their reading ability. We compared the reading speed of 63 school-age (10–14 years) children with IXT to 44 age-matched normal counterparts. In addition, the correlation between reading speed and clinical characteristics of IXT were evaluated. The reading speed in children with IXT was 231 ± 51 CPM, while reading speed in normal counterparts was 257 ± 33 CPM. Age, gender were found to be factors associated with reading speed in children with IXT. After adjusting for the age and gender, we found a significant correlation between the LogTNO and reading speed in IXT group based on a generalized linear model (p = 0.014). These data show that reading speed was slower in school-age children with IXT assessed with the International Reading Speed Texts. When age and gender were adjusted, poor stereo function at near was found to be related with a slower reading speed.
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Şahin AA, Şahin AK, Uzun A, Değirmenci E. The relationship between extremity fractures and visual impairment in childhood: A case-control study. ULUS TRAVMA ACIL CER 2022; 28:662-667. [PMID: 35485477 PMCID: PMC10442978 DOI: 10.14744/tjtes.2022.90235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/27/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Fractures are common extremity injuries in pediatric orthopedic practice. The aim of this study is to determine the relationship between pediatric extremity fractures and visual impairments. METHODS Thirty pediatric patients who were admitted to the emergency and orthopedics and traumatology clinic due to an extremity fracture after a fall were included in the study. Following fracture treatment, the patients were evaluated in terms of ocu-lar findings before discharge from the hospital. Thirty age- and sex-matched healthy children who presented to the ophthalmology department for routine care were also recruited as the control group. All participants underwent a comprehensive ophthalmologic examination, including cycloplegic refraction, visual acuity levels, and near stereoacuity measurement. RESULTS The number of male participants was higher in both groups. There was no significant difference between the groups in terms of age and gender distribution. The most common upper extremity fractures were observed to be distal radius (52%) and distal humerus fractures (28%). The number of patients who had a refractive error that required spectacles was significantly higher in the fracture group (p=0.039). When the visual acuity levels of the better eye were evaluated, the mean visual acuity was significantly lower in the fracture group (p=0.016). The mean stereoacuity was also significantly lower in the study group (<0.001). In the binary logistic regression analysis model, low stereopsis levels were associated with the risk of pediatric extremity fractures (95% CI: 1.056-1.385; p=0.006). CONCLUSION Our study showed that low-energy pediatric extremity fractures are more common in children with visual im-pairments that require treatment, and low stereopsis is a risk factor for fractures. Consequently, regular eye examinations and early treatment of visual impairments in children may help to prevent fall-related injuries.
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Affiliation(s)
- Abdullah Alper Şahin
- Department of Orthopaedic and Traumatology, Ordu University Training and Research Hospital, Ordu-Turkey
| | - Asena Keleş Şahin
- Department of Ophthalmology, Ordu University Training and Research Hospital, Ordu-Turkey
| | - Aslıhan Uzun
- Department of Ophthalmology, Ordu University Training and Research Hospital, Ordu-Turkey
| | - Erdem Değirmenci
- Department of Orthopaedic and Traumatology, Şişli Kolan International Hospital, İstanbul-Turkey
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Hou SW, Zhang Y, Christian L, Niechwiej‐Szwedo E, Giaschi D. Evaluating visuomotor coordination in children with amblyopia. Dev Psychobiol 2022; 64:e22270. [DOI: 10.1002/dev.22270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/05/2022] [Accepted: 02/20/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Sabrina W. Hou
- Department of Ophthalmology and Visual Sciences University of British Columbia Vancouver British Columbia Canada
| | - Yan Zhang
- Department of Ophthalmology and Visual Sciences University of British Columbia Vancouver British Columbia Canada
| | - Lisa Christian
- Department of Optometry and Vision Science University of Waterloo Waterloo Ontario Canada
| | | | - Deborah Giaschi
- Department of Ophthalmology and Visual Sciences University of British Columbia Vancouver British Columbia Canada
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Strabismus Surgery Decreases the Risk of Injuries in Pediatric Patients in the OptumLabs Data Warehouse. Am J Ophthalmol 2022; 236:147-153. [PMID: 34283972 DOI: 10.1016/j.ajo.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE 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. DESIGN Retrospective cohort study. METHODS 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. RESULTS 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). DISCUSSION 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.
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Jia Y, Ye Q, Zhang S, Feng L, Liu J, Xu Z, Zhuang Y, He Y, Zhou Y, Chen X, Yao Y, Jiang R, Thompson B, Li J. Contrast Sensitivity and Stereoacuity in Successfully Treated Refractive Amblyopia. Invest Ophthalmol Vis Sci 2022; 63:6. [PMID: 34989762 PMCID: PMC8742522 DOI: 10.1167/iovs.63.1.6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess whether monocular contrast sensitivity and stereoacuity impairments remain when visual acuity is fully recovered in children with refractive amblyopia. Methods A retrospective review of 487 patients diagnosed with refractive amblyopia whose visual acuity improved to 0.08 logMAR or better in both eyes following optical treatment was conducted. Measurements of monocular contrast sensitivity and stereoacuity had been made when visual acuity normalized. All patients had been treated with refractive correction for approximately 2 years following diagnosis. No other treatments were provided. Monocular contrast sensitivity was measured using the CSV-1000E chart for children 6 years of age or younger and a psychophysical technique called the quick contrast sensitivity function in older children. Stereoacuity was measured using the Random Dot Test that includes monocular cues and the Randot Stereoacuity Test that does not have monocular cues. Results Statistically significant interocular differences in contrast sensitivity were observed. These differences tended to occur at higher spatial frequencies (12 and 18 cycles per degree). Stereoacuity within the age-specific normal range was achieved by 47.4% of patients for the Random Dot Test and only 23.1% of patients for the Randot Stereoacuity Test. Conclusions Full recovery of visual acuity following treatment for refractive amblyopia does not equalize interocular contrast sensitivity or restore normal stereopsis. Alternative therapeutic approaches that target contrast sensitivity and/or binocular vision are required.
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Affiliation(s)
- Yu Jia
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Centre for Eye and Vision Research, 17W Science Park, Hong Kong
| | - Qingqing Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shenglan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lei Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zixuan Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yijing Zhuang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yunsi He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yusong Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaolan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ying Yao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Rengang Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Benjamin Thompson
- Centre for Eye and Vision Research, 17W Science Park, Hong Kong.,School of Optometry and Vision Science, University of Waterloo, Waterloo, Ontario, Canada.,Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Jinrong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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20
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Pineles SL, Repka MX, Yu F, Velez FG, Doppee D, Perez C, Sim D, Coleman AL. Risk of physical injuries in children and teens with ophthalmic diagnoses in the OptumLabs Data Warehouse. J AAPOS 2021; 25:346.e1-346.e7. [PMID: 34655769 DOI: 10.1016/j.jaapos.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate how eye diseases affect the risk of injuries (fractures, musculoskeletal, head and eye injuries) in children and teens. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Stacy L Pineles
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles; OptumLabs, Eden Prairie, Minnesota.
| | - Michael X Repka
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fei Yu
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles; Department of Biostatistics, University of California Los Angeles, Fielding School of Public Health
| | - Federico G Velez
- Department of Ophthalmology, Doheny Eye Institute, University of California, Los Angeles; Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Danielle Doppee
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles
| | - Claudia Perez
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles
| | - Danielle Sim
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles
| | - Anne L Coleman
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles; Department of Epidemiology, University of California Los Angeles, Fielding School of Public Health
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Kelly KR, Hunter J, Norouzi DM, Jost RM, White AJ, Cheng-Patel CS, Beauchamp CL, Dao LM, Luu BA, Stager D, Tung JY, Niechwiej-Szwedo E. Reach Kinematics During Binocular Viewing in 7- to 12-Year-Old Children With Strabismus. Invest Ophthalmol Vis Sci 2021; 62:21. [PMID: 34935884 PMCID: PMC8711010 DOI: 10.1167/iovs.62.15.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Purpose Eye–hand coordination is essential for normal development and learning. Discordant binocular experience from childhood strabismus results in sensory and ocular motor impairments that can affect eye–hand coordination. We assessed reach kinematics during visually guided reaching in children treated for strabismus compared with controls. Methods Thirty-six children aged 7 to 12 years diagnosed with esotropia, a form of strabismus, and a group of 35 age-similar control children were enrolled. Reach movements during visually guided reaching were recorded using the LEAP Motion Controller. While viewing binocularly, children reached out and touched a small dot that appeared randomly in one of four locations (±5° or ±10°). Kinematic measures were reach reaction time, total reach duration, peak velocity, acceleration duration, and deceleration duration. Touch accuracy and factors associated with impaired reach kinematics were evaluated. Results Strabismic children had longer total reach duration (545 ± 60 ms vs. 504 ± 43 ms; P = 0.002), had longer deceleration duration (343 ± 54 ms vs. 312 ± 45 ms; P = 0.010), and were less accurate (93% ± 6% vs. 96% ± 5%, P = 0.007) than controls. No differences were found for reach reaction time, peak velocity, or acceleration duration (all Ps ≥ 0.197). Binocular dysfunction was more related to slow reaching than amblyopic eye visual acuity. Conclusions Strabismus affects visually guided reaching in children, with slower reaching in the final approach and reduced endpoint accuracy. Binocular dysfunction was predictive of slow reaching. Unlike strabismic adults who show longer acceleration duration, longer deceleration in the final approach in strabismic children indicates a difference in control that could be due to reduced ability to use visual feedback.
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Affiliation(s)
- Krista R Kelly
- Retina Foundation of the Southwest, Dallas, Texas, United States.,Department of Ophthalmology, UT Southwestern Medical Center, Dallas, Texas, United States
| | - Jeffrey Hunter
- Retina Foundation of the Southwest, Dallas, Texas, United States
| | | | - Reed M Jost
- Retina Foundation of the Southwest, Dallas, Texas, United States
| | - Ashley J White
- Retina Foundation of the Southwest, Dallas, Texas, United States
| | | | | | - Lori M Dao
- ABC Eyes Pediatric Ophthalmology, PA, Dallas, Texas, United States
| | - Becky A Luu
- Pediatric Ophthalmology & Adult Strabismus, PA, Plano, Texas, United States
| | - David Stager
- Pediatric Ophthalmology & Adult Strabismus, PA, Plano, Texas, United States
| | - James Y Tung
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario, Canada
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Birch EE, Kelly KR, Wang J. Recent Advances in Screening and Treatment for Amblyopia. Ophthalmol Ther 2021; 10:815-830. [PMID: 34499336 PMCID: PMC8589941 DOI: 10.1007/s40123-021-00394-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022] Open
Abstract
Amblyopia is the most common cause of monocular visual impairment in children, with a prevalence of 2-3%. Not only is visual acuity reduced in one eye but binocular vision is affected, fellow eye deficits may be present, eye-hand coordination and reading can be affected, and self-perception may be diminished. New technologies for preschool vision screening hold promise for accessible, early, and accurate detection of amblyopia. Together with recent advances in our theoretical understanding of amblyopia and technological advances in amblyopia treatment, we anticipate improved visual outcomes for children affected by this very common eye condition. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
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Affiliation(s)
- Eileen E Birch
- Retina Foundation of the Southwest, 9600 N. Central Expressway, Suite 200, Dallas, TX, 75231, USA.
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Krista R Kelly
- Retina Foundation of the Southwest, 9600 N. Central Expressway, Suite 200, Dallas, TX, 75231, USA
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jingyun Wang
- SUNY College of Optometry, State University of New York, New York, NY, USA
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23
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Niechwiej-Szwedo E, Wu S, Nouredanesh M, Tung J, Christian LW. Development of eye-hand coordination in typically developing children and adolescents assessed using a reach-to-grasp sequencing task. Hum Mov Sci 2021; 80:102868. [PMID: 34509902 DOI: 10.1016/j.humov.2021.102868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/11/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022]
Abstract
Eye-hand coordination is required to accurately perform daily activities that involve reaching, grasping and manipulating objects. Studies using aiming, grasping or sequencing tasks have shown a stereotypical temporal coupling pattern where the eyes are directed to the object in advance of the hand movement, which may facilitate the planning and execution required for reaching. While the temporal coordination between the ocular and manual systems has been extensively investigated in adults, relatively little is known about the typical development of eye-hand coordination. Therefore, the current study addressed an important knowledge gap by characterizing the profile of eye-hand coupling in typically developing school-age children (n = 57) and in a cohort of adults (n = 30). Eye and hand movements were recorded concurrently during the performance of a bead threading task which consists of four distinct movements: reach to bead, grasp, reach to needle, and thread. Results showed a moderate to high correlation between eye and hand latencies in children and adults, supporting that both movements were planned in parallel. Eye and reach latencies, latency differences, and dwell time during grasping and threading, showed significant age-related differences, suggesting eye-hand coupling becomes more efficient in adolescence. Furthermore, visual acuity, stereoacuity and accommodative facility were also found to be associated with the efficiency of eye-hand coordination in children. Results from this study can serve as reference values when examining eye and hand movement during the performance of fine motor skills in children with neurodevelopmental disorders.
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Affiliation(s)
- Ewa Niechwiej-Szwedo
- Kinesiology, University of Waterloo, 200 University Ave W, Waterloo ON N2L 3G1, Canada.
| | - Susana Wu
- Kinesiology, University of Waterloo, 200 University Ave W, Waterloo ON N2L 3G1, Canada
| | - Mina Nouredanesh
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave W, Waterloo ON N2L 3G1, Canada
| | - James Tung
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave W, Waterloo ON N2L 3G1, Canada
| | - Lisa W Christian
- School of Optometry and Vision Science, University of Waterloo, 200 University Ave W, Waterloo ON N2L 3G1, Canada
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Black AA, Wood JM, Hoang S, Thomas E, Webber AL. Impact of Amblyopia on Visual Attention and Visual Search in Children. Invest Ophthalmol Vis Sci 2021; 62:15. [PMID: 33848323 PMCID: PMC8054626 DOI: 10.1167/iovs.62.4.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/19/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose The purpose of this study was to compare binocular visual attention, visual processing speeds, and visuo-cognitive search ability in children with and without amblyopia and investigate the association of visual acuity and binocular function with these measures. Methods Participants included 20 children with amblyopia (mean age = 9.0 ± 1.2 years; 15 anisometropic and 5 strabismic) and 20 children with normal vision development (9.5 ± 1.7 years). Vision assessment included visual acuity (monocular and binocular) and binocular function (Worth 4 Dot and Randot Preschool Stereotest). Visual attention and processing speeds were assessed using the three subtests of the Useful Field of View (UFOV; central processing, divided attention, and selective attention). Visuo-cognitive search was measured using static and dynamic presentations of the Trail Making Tests (TMTs), parts A and B, with increasing levels of executive function demand. All children performed these tasks binocularly. Results Children with amblyopia demonstrated slower visual processing times on the UFOV (P = 0.04), and slower completion times on the TMT search tests (P = 0.014), compared to controls. TMT performance for children with amblyopia was also more negatively impacted with increasing executive function demands on the TMT part B, compared to controls (P = 0.005). Binocular visual acuity was associated with TMT (P = 0.006) and UFOV (P = 0.07) performance, but none of the other visual function measures were related to performance on these tasks. Conclusions Children with amblyopia exhibit deficits in higher-order visual processing skills, including visual attention and visual search, particularly with increasing executive function demands. These findings have implications for understanding the impact of amblyopia on everyday function in children.
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Affiliation(s)
- Alex A. Black
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Joanne M. Wood
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Silvie Hoang
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Eloise Thomas
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
| | - Ann L. Webber
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Brisbane, Australia
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