Onset and progression of with-the-rule astigmatism in children with infantile nystagmus syndrome.

PURPOSE: The purpose of this study was to examine the onset and progression of with-the-rule (WTR) astigmatism during the first 8 years of life in children with idiopathic infantile nystagmus syndrome (INS) or INS associated with albinism and to compare their development with that of normal children. Also explored was whether early WTR astigmatism influences emmetropization in children with INS and whether there is evidence of meridional emmetropization. METHODS: Cycloplegic refractions culled from medical records were converted into power vector components: M (spherical equivalent), J(0) (positive J(0) indicates WTR astigmatism), and J(45) (oblique astigmatism). Two diagnostic groups (idiopathic, n = 106; albinism, n = 95) were evaluated and compared with a reference normal group (n = 495). Four age subgroups were evaluated: age< or =0.5 year, 0.5

The teller acuity cards are effective in detecting amblyopia.

PURPOSE: Detection of amblyopia in infants and toddlers is difficult because the current clinical standard for this age group, fixation preference, is inaccurate. Although grating acuity represents an alternative, studies of preschoolers and schoolchildren report that it is not equivalent to the gold standard optotype acuity. Here, we examine whether the Teller Acuity Cards (TAC) can detect amblyopia effectively by testing children old enough (7.8 +/- 3.6 years) to complete optotype acuity testing. METHODS: Grating acuity was assessed monocularly in 45 patients with unilateral amblyopia, 44 patients at risk for amblyopia, and 37 children with no known vision disorders. Each child's grating acuity was classified as normal/abnormal based on age-appropriate norms. These classifications were compared with formal amblyopia diagnoses. RESULTS: Grating acuity was finer than optotype acuity among amblyopic eyes (medians: 0.28 vs. 0.40 logMAR, respectively, p < 0.0001) but not among fellow eyes (medians: 0.03 vs. 0.10 logMAR, respectively, p = 0.36). The optotype acuity-grating acuity discrepancy among amblyopic eyes was larger for cases of severe amblyopia than for moderate amblyopia (means: 0.64 vs. 0.18 logMAR, respectively, p = 0.0001). Nevertheless, most cases of amblyopia were detected successfully by the TAC, yielding a sensitivity of 80%. Furthermore, grating acuity was relatively sensitive to all amblyopia subtypes (69 to 89%) and levels of severity (79 to 83%). CONCLUSIONS: Although grating acuity is finer than optotype acuity in amblyopic eyes, most children with amblyopia were identified correctly suggesting that grating acuity is an effective clinical alternative for detecting amblyopia.