Impaired Motor Skills of Children with Anisometropia and Strabismus


The latest research from the prolific group at the Retina Foundation of the Southwest, including Krista Kelly and Eileen Birch, involving motor skills in children with strabismus, has been published in Investigative Ophthalmology & Visual Science. Dr. Fortenbacher previously blogged about research from this group as it pertains to amblyopia.

The key conclusion from the new paper is as follows: “Amblyopia and strabismus disrupt the development of motor ability in children. These findings highlight the widespread effects of discordant binocular input early in life and the visual acuity and binocularity deficits typical of these eye conditions.”

Children involved in the study ranged from age 3 – 13, and had a history of strabismus or anisometropia, with or without amblyopia. The researchers evaluated fine and gross motor skills during binocular viewing using the Movement Assessment Battery for Children, Second Edition (MABC-2).

Tasks for the Manual Dexterity, Aiming and Catching, and Balance Subscales in the MABC-2 were reported as follows:

The authors note that discordant binocular input during infancy and childhood may disrupt the ability to use these cues during motor development, which is evident by their finding of poorer performance with an infantile onset of the eye condition. Children with anisometropia in their study had a later mean age at diagnosis than those with strabismus . Although better binocularity in anisometropic children likely contributed to the lack of deficits seen for the Aiming and Catching and Balance subscales, the later onset of anisometropia may also play a role.  Children with normal stereoacuity and normal depth of suppression in their study did not score lower than controls on any subscale, consistent with earlier studies showing better motor performance in those with recovered binocularity and suggesting that binocularity is essential to task performance. 

This adds to the growing body of evidence that the impairments in strabismus and amblyopia are associated with more than deficits in visual acuity, stereoacuity, and binocular integration.  It also has implications for the importance of assessing successful outcomes in the treatment of these conditions beyond surgery, occlusion, or atorpine penalization.  The nonamblyopic group included only strabismic children aligned within 6 prism diopters of orthotropia at the time of testing, which means that they would have been considered “cured” according to traditional criteria yet could potentially benefit further from low amounts of prism or other forms of therapy to aid binocular integration.  Nor did the authors find any correlation in children with amblyopia between the depth of amblyopia and the extent of motor abnormalities.  The conclusion therefore is that a fundamental disruption in binocular development, irrespective of the extent of amblyopia, underlies the motor abnormalities observed.  As the authors review, this has pervasive effects from ball-playing to early academic skills, and therefore warrants more comprehensive assessment and treatment.

We are going to be featuring this article on Elsevier’s Practice Update Eyecare this week, and in my comments I observe:

This adds to the growing body of evidence that the impairments in strabismus and amblyopia are associated with more than deficits in visual acuity, stereoacuity, and binocular integration.  It also has implications for the importance of assessing successful outcomes in the treatment of these conditions beyond surgery, occlusion, or atropine penalization.  The nonamblyopic group included only strabismic children aligned within 6 prism diopters of orthotropia at the time of testing, which means that they would have been considered “cured” according to traditional criteria yet could potentially benefit further from low amounts of prism or other forms of therapy to aid binocular integration.  Nor did the authors find any correlation in children with amblyopia between the depth of amblyopia and the extent of motor abnormalities.  The conclusion therefore is that a fundamental disruption in binocular development, irrespective of the extent of amblyopia, underlies the motor abnormalities observed.  As the authors review, this has pervasive effects from ball-playing to early academic skills, and therefore warrants more comprehensive assessment and treatment.

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