Associations of Eye-Related Quality of Life With Vision, Visuomotor Function, and Self-Perception in Children With Strabismus and Anisometropia.

Purpose: To evaluate associations between eye-related quality of life (ER-QOL) assessed by the Child Pediatric Eye Questionnaire (Child PedEyeQ) and functional measures (vision, visuomotor function, self-perception) in children with strabismus, anisometropia, or both. Our hypothesis was that children with functional deficits would have lower ER-QOL, and if so, these associations would support the convergent construct validity of the Child PedEyeQ. Methods: We evaluated 114 children (ages 5-11 years) with strabismus, anisometropia, or both. Each child completed the Child PedEyeQ to assess four Rasch-scored domains of ER-QOL: Functional Vision, Bothered by Eyes/Vision, Social, and Frustration/Worry. In addition, children completed one or more functional tests: visual acuity (n = 114), Randot Preschool Stereoacuity (n = 92), contrast balance index (suppression; n = 91), Readalyzer reading (n = 44), vergence instability (n = 50), Movement Assessment Battery for Children-2 manual dexterity (n = 57), and Pictorial Scale of Perceived Competence and Social Acceptance for Young Children (n = 44). Results: Child PedEyeQ Functional Vision domain scores were correlated with self-perception of physical competence (rs = 0.65; 95% confidence interval [CI], 0.35-0.96) and reading speed (rs = 0.47; 95% CI, 0.16-0.77). Bothered by Eyes/Vision domain scores were correlated with self-perception of physical competence (rs = 0.52; 95% CI, 0.21-0.83). Moderate correlations were observed between Social domain scores and vergence instability (rs = -0.46; 95% CI, -0.76 to -0.15) and self-perception of physical competence (rs = 0.43; 95% CI, 0.12-0.73) and peer acceptance (rs = 0.49; 95% CI, 0.18-0.80). Frustration/Worry domain scores were moderately correlated with self-perception of physical competence (rs = 0.41; 95% CI, 0.10-0.71) and peer acceptance (rs = 0.47; 95% CI, 0.16-0.77). Conclusions: Strong and moderate correlations were observed between functional measures and Child PedEyeQ domain scores. These associations provide supporting evidence that the Child PedEyeQ has convergent construct validity.

Comparison of perceptual eye positions among patients with different degrees of anisometropia.

The aim of this study is to compare the perceptual eye positions (PEPs) among patients with different degrees of anisometropia.A total of 157 patients were recruited into this retrospective study. A detailed ophthalmic examination was conducted on each patient. The degree of refractive errors in the presence of astigmatism was converted into the degree of spherical equivalent (SE). Patients were divided into 3 groups according to the interocular SE difference: severe anisometropia group with interocular SE difference ≥2.50D, mild anisometropia group with interocular SE difference ≥1.00D and <2.50D, and non-anisometropia group with interocular SE difference <1.00D. The vertical and horizontal PEP were measured by a computer-controlled perceptual examination evaluation system. The results obtained from the 3 groups were compared and analyzed.A total of 157 patients were enrolled including 32 patients in the severe anisometropia group, 37 patients in the mild anisometropia group, and 88 patients in the non-anisometropia group. The quartiles of vertical PEP pixels were as follows: 7.50 (5.00, 16.75) in the severe anisometropia group, 5.00 (2.00, 7.50) in the mild anisometropia group, and 5.00 (3.00, 9.00) in the non-anisometropia group, respectively. The vertical PEP pixel was much higher in the severe anisometropia group than that in the other two groups (P < .05). The quartiles of horizontal PEP pixels were as follows: 27.50 (10.75, 67.50) in the severe anisometropia group, 17.00 (7.00, 54.50) in the mild anisometropia group, and 21.50 (11.00, 60.75) in the non-anisometropia group. There were no statistically significant differences among the 3 groups (P > .05).There was an obvious deviation of vertical PEP in patients with anisometropia ≥2.50D, indicating that the instability of vertical PEP might be associated with the development of severe anisometropia.

Stereopsis in children with unilateral pseudophakia.

AIM: To evaluate stereoacuity and the factors that can influence stereopsis in children with unilateral pseudophakia. METHODS: Charts of 38 patients who were diagnosed as having unilateral cataract and underwent cataract extraction with primary intraocular lens implantation were retrospectively reviewed. Data were collected on gender, age, race, age at presentation and the surgery, cataract types, the presence of strabismus before and after cataract extraction, refractive error and the presence of anisometropia, best corrected visual acuity (VA) of both eyes and stereoacuity. RESULTS: Thirty-eight patients were divided into two groups. Group I had 21 patients whose stereopsis was better than 400 s of arc. Seventeen patients in group II had stereopsis poorer than 400 s of arc. The mean ages at presentation and surgery were 4.9 and 6.3 years in group I and 2.7 and 3.0 in group II, respectively (p = 0.046,0.007). Posterior lenticonus was the most common cataract type in both groups (p = 0.20). Strabismus was more frequently associated with group II. Those who had no strabismus before and after cataract surgery were 66.7% in group I and 47.1% in group II (p = 0.02). Fifty-two per cent of patients in group I had a VA of 20/40 or better, but in group II, only one patient had a VA of 20/40 (p<0.001). With a VA of 20/40 or better as the reference level, the odds of having good stereopsis decreased significantly if VA in the eye with the cataract was less than 20/60 based on the multiple regression logistic analysis (OR 0.03, p = 0.0027). CONCLUSION: Stereopsis was better in children with later manifesting cataracts, in the absence of strabismus and in cases with a good postoperative VA. The postoperative VA was the most important factor affecting the outcome of stereopsis in children with unilateral pseudophakia.

Stereopsis-dependent deficits in maximum motion displacement in strabismic and anisometropic amblyopia.

Direction discrimination thresholds for maximum motion displacement (D(max)) have been previously reported to be abnormal in amblyopic children [Ho, C. S., Giaschi, D. E., Boden, C., Dougherty, R., Cline, R., & Lyons, C. (2005). Deficient motion perception in the fellow eye of amblyopic children. Vision Research, 45, 1615-1627; Ho, C. S., & Giaschi, D. E. (2006). Deficient maximum motion displacement in amblyopia. Vision Research, 46, 4595-4603]. We looked at D(max) thresholds for random dot kinematograms (RDKs) biased toward low- or high-level motion mechanisms. D(max) is thought to be limited, for high-level motion mechanisms, by the efficiency of object feature tracking and probability of false matches. To reduce the influence of low-level mechanisms, we determined thresholds also for a high-pass filtered version of the RDKs. Performance did not significantly differ between strabismic and anisometropic groups with amblyopia, although both groups performed significantly worse than the age-matched control group. D(max) thresholds were higher for children with poor stereoacuity. This was significant in both anisometropic and strabismic groups, and more robust for high-pass filtered RDKs than for unfiltered RDKs. The results imply that impairment of the extra-striate dorsal stream is a likely part of the neural deficit underlying both strabismic and anisometropic amblyopia. This deficit appears to be more dependent on extent of binocularity than etiology. Our findings suggest a possible relationship between fine stereopsis, coarse stereopsis, and motion correspondence mechanisms.

Local and non-local deficits in amblyopia: acuity and spatial interactions.

Amblyopic vision is thought to be limited by abnormal long-range spatial interactions, but their exact mode of action and relationship to the main amblyopic deficit in visual acuity is largely unknown. We studied this relationship in a group (N=59) of anisometropic (N=21) and strabismic (or combined, N=38) subjects, using (1) a single and multi-pattern (crowded) computerized static Tumbling-E test with scaled spacing of two pattern widths (TeVA), in addition to an optotype (ETDRS chart) acuity test (VA) and (2) contrast detection of Gabor patches with lateral flankers (lateral masking) along the horizontal and vertical axes as well as in collinear and parallel configurations. By correlating the different measures of visual acuity and contrast suppression, we found that (1) the VA of the strabismic subjects could be decomposed into two uncorrelated components measured in TeVA: acuity for isolated patterns and acuity reduction due to flanking patterns. The latter comprised over 60% of the VA magnitude, on the average and accounted for over 50% of its variance. In contrast, a slight reduction in acuity was found in the anisometropic subjects, and the acuity for a single pattern could account for 70% of the VA variance. (2) The lateral suppression (contrast threshold elevation) in a parallel configuration along the horizontal axis was correlated with the VA (R2=0.7), as well as with the crowding effect (TeVA elevation, R2=0.5) for the strabismic group. Some correlation with the VA was also found for the collinear configuration in the anisometropic group, but less suppression and no correlation were found for all the vertical configurations in all the groups. The results indicate the existence of a specific non-local component of the strabismic deficit, in addition to the local acuity deficit in all amblyopia types. This deficit might reflect long-range lateral inhibition, or alternatively, an inaccurate and scattered top-down attentional selection mechanism.

Lateral interactions in amblyopia.

We studied lateral neural interactions in strabismic (n=6) and anisometropic amblyopes (n=3) by measuring reductions in the perceived contrast of a foveally viewed Gabor centred in a horizontal array of closely neighboring Gabors. Strabismic amblyopes, but not anisometropic amblyopes, failed to show the reduction in perceived contrast typical of normal vision [J. Opt. Soc. Amer. A 15 (1998) 1733] when lateral contrast information is available at the same orientation and spatial frequency. The strabismic amblyopes also severely misperceive the regularity of the array of Gabors flanking the test stimulus. A normal eye could model the anomalous contrast perception of the amblyopic eye, by adding an equivalent amount of spatial distortion to the stimulus. The relationship between the observed anomalies for local contrast gain control and positional sensitivity is discussed.

Social deprivation and age at presentation in amblyopia.

BACKGROUND: Amblyopia is the most common visual disability in children. Early treatment is thought to be more effective, and therefore factors affecting the age at presentation are important. A relationship between social deprivation and access to health care and screening services is well known. We hypothesized that social deprivation might be associated with later presentation of amblyopia, particularly of anisometropic amblyopia which depends on vision screening for referral. METHODS: Data from a historical cohort of 897 children with amblyopia, from seven UK orthoptic clinics, were used to test this hypothesis. Social deprivation was measured by the Townsend score of the ward in which the child lived. RESULTS: A relationship between social deprivation and age at presentation was found in children with anisometropic amblyopia even after adjusting for differences between clinics (p = 0.01) but no similar association was evident in children with amblyopia associated with strabismus. There was a difference of 22 months in the average age at presentation between children with anisometropic amblyopia in the most deprived and least deprived areas of the study. CONCLUSIONS: If screening for anisometropic amblyopia is to be undertaken, priority should be given to screening children from areas of social deprivation.

Interocular suppression in normal and amblyopic subjects: the effect of unilateral attenuation with neutral density filters.

In normal subjects, binocular rivalry suppression takes time to build up (Wolfe, 1986a). The time courses of interocular suppression are different and heterogeneous in amblyopic subjects (de Belsunce & Sireteanu, 1991). In the present study, we found that, in normal observers, progressive reduction of one eye's stimulus luminance with neutral density filters produces time courses similar to those of amblyopic subjects. Conversely, in amblyopes, attenuation of the dominant eye's stimulus produces time courses similar to those of normal observers. Under conditions of balancing of the two eyes, amblyopes experience alternating suppression, similarly to binocular rivalry of normals.

The spatial localization deficit in amblyopia.

There have now been numerous reports of a spatial localization deficit in amblyopia but none so far have tackled (1) the relationship between the contrast sensitivity and spatial localization deficits and (2) whether the spatial localization deficit is best described in units of visual angle or in terms of the underlying filter size. These issues are germane because they lie at the very heart of our understanding of the underlying deficit in amblyopia. To answer these questions we use spatially bandpass stimuli so that we can readily compare detection and localization for the same stimuli at each of a number of spatial scales. For some amblyopes (all strabismics and a minority of anisometropes) the contrast sensitivity defect neither underlies nor covaries with the spatial localization deficit. In the majority of anisometropic amblyopes, the contrast sensitivity loss is a complete description. The spatial localization deficit in amblyopia is of two independent kinds; positional inaccuracy and positional distortion. The positional inaccuracy deficit which can occur in varying degrees in both strabismic and anisometropic amblyopia, affects all spatial scales equally and therefore is best thought of in terms of a constant fraction of the underlying filter size in the space-frequency plane. The positional distortion deficit which can also occur to varying degrees in both strabismic and anisometropic forms can not be easily understood within this metric at least for strabismics.

Equivalent intrinsic blur in amblyopia.

We used Gaussian blurred stimuli to explore the effect of blur on three tasks: (i) 2-line resolution; (ii) line detection; and (iii) spatial interval discrimination, in observers with amblyopia due to anisometropia, strabismus, or both. The results of our experiments can be summarized as follows. (i) 2-Line resolution: in normal foveal vision, thresholds for unblurred stimuli are approx. 0.5 min arc in the fovea. When the standard deviation (sigma) of the stimulus blur is less than 0.5 min, it has little effect upon 2-line resolution; however, thresholds are degraded when the stimulus blur, sigma, exceeds 0.5 min. We operationally define this transition point, as the equivalent intrinsic blur, or Bi. When the stimulus blur, sigma, is greater than Bi, then the resolution threshold is approximately equal to sigma. In all of the amblyopic eyes, 2-line resolution thresholds for unblurred stimuli were elevated, and the equivalent intrinsic blur was much larger. When the stimulus blur exceeds the equivalent intrinsic blur, resolution thresholds were similar in amblyopic and nonamblyopic eyes. (ii) Line detection: in both normal and amblyopic eyes, when the stimulus blur, sigma, is less than Bi, then the line detection threshold is approximately inversely proportional to sigma; i.e. (it obeys Ricco's law). When sigma is greater than Bi, the equivalent intrinsic blur, then the detection threshold is approximately a fixed contrast. All of the amblyopic eyes showed markedly elevated thresholds for detecting thin lines, but normal or near normal thresholds for detecting very blurred lines. Consequently, Ricco's diameter is larger in amblyopic than in normal eyes. (iii) Spatial interval discrimination: thresholds are proportional to the separation of the lines (i.e. Weber's law). At the optimal separation, spatial interval discrimination thresholds represent a "hyperacuity" (i.e. they are smaller than the resolution threshold). For unblurred lines, the optimal separation is approx. 2-3 times Bi. In the normal fovea, and in the amblyopic eyes of anisometropic amblyopes the optimal spatial interval discrimination threshold is about one-fifth of the resolution threshold (i.e. a hyperacuity); and over a wide range of separations, spatial interval discrimination thresholds begin to rise when the stimulus blur exceeds about one-third of the separation between the lines as long as the contrast is sufficiently high. In contrast, in strabismic amblyopes, like the normal periphery, the optimal spatial interval discrimination thresholds are worse (higher) than would be expected based upon the resolution limit of the strabismic amblyopic eye.(ABSTRACT TRUNCATED AT 400 WORDS)