Motor skills of children with unilateral visual impairment in the Infant Aphakia Treatment Study

School performances in children with cataract: results from a population-based cohort study

OBJECTIVES

Childhood cataract is a chronic condition that may interfere with the child's learning capacities. We aimed to investigate whether childhood cataract influences academic development by comparing school performance in reading and mathematics in children with cataract to a matched control group.

DESIGN

Nationwide registry-based cohort study.

SETTINGS

Two surgical centres that perform all treatments for childhood cataract in Denmark.

PARTICIPANTS

Children born between 2000 and 2009 diagnosed with cataract before 10 years of age (n=275) and an age-matched and sex-matched control group (n=2473).

MAIN OUTCOME MEASURES

School performance was assessed as test scores in national tests performed at regular intervals from grade 2 to grade 8 in reading and mathematics. Analyses were corrected for birth origin, child somatic and mental disorder and parental socioeconomic status and mental disorders.

RESULTS

Of 275 children, 85 (30.9%) were operated for bilateral cataract, 79 (28.7%) unilateral cataract and 111 (40,4%) were not operated. We found that children with cataract have lower participation rate in the tests (62.5%) compared with the control cohort (77.2%) (p value=0.0001). After adjusting the pooled analyses for birth origin, somatic and mental disease in the child and parental socioeconomic status and mental disorders, we found that the children with cataract scored significantly lower in mathematics compared with those without cataract (mean difference=-4.78, 95% CI: -8.18 to -1.38, p value=0.006), whereas no difference was found regarding scores in reading (p=0.576). The lower score in mathematics was driven by children who had been operated for bilateral cataract (p-value=0.004).

CONCLUSION

Children with cataract without somatic or neurodevelopmental comorbidities or psychosocial adversities seem to do well in school, whereas children operated for bilateral cataract have higher frequencies of difficulties in mathematical tasks.

A Study of Improving Independent Walking Outcomes in Children Who Are Blind or Have Low Vision Aged 5 Years and Younger

Walking alone (without assistance) is considered by the World Health Organization as the terminal independent walking milestone, typically achieved by 18 months. Children born with severe visual impairment and blindness (visual impairments) do not achieve independent walking milestones on time. This study examined independent walking in 35 children with visual impairments (VIs) aged 14–69 months. Before treatment, they had limited to no anticipatory control. Wearing the pediatric belt cane (PBC) provided them with consistent, tactile anticipatory control. Thirty-five participants with VIs’ independent walking milestones were analyzed using pre- and post-video recordings provided weekly 1 month before and the 3 months after obtaining the PBC. The PBC consisted of a rectangular frame that connects to a custom-made belt with magnets. The PBC provided no weight support. While none of the participants had motor impairments, 80% of them were receiving physical therapy services prior to obtaining a PBC. Fifty-four percent were receiving orientation and mobility services, and half were equipped with hand-held mobility tools (long canes, adaptive mobility devices, push toys, and reverse walkers). A paired samples t-test indicated a significant difference between the before and with PBC scores ( N = 35, t = −13.0, df = 34, p = .000). Participants demonstrated significantly improved independent walking after wearing their PBC regularly over 3 months. Before PBC, the participants demonstrated delayed independent walking milestones. Most participants walked only with assistance. Those who walked independently experienced unavoidable bodily collisions and used a slow pace with poor gait patterns. After being provided PBCs, these same participants’ independent walking milestones improved, all but three were walking independently and five were observed independently running. Wearing their PBCs allowed them to perform motor skills, like running, often described as needing to be specifically taught to learners with VIs due to their inability to learn incidentally through visual observation.

Retinoblastoma and vision

The assessment of vision has a growing importance in the management of retinoblastoma in the era of globe-conserving therapy, both prior to and after treatment. As survival rates approach 98-99% and globe salvage rates reach ever-higher levels, it is important to provide families with information regarding the visual outcomes of different treatments. We present an overview of the role of vision in determining the treatment given and the impact of complications of treatment. We also discuss screening and treatment strategies that can be used to maximise vision.

Early Intervention Orientation and Mobility: A Delphi Study of the Content of the Birth to 6 Orientation and Mobility Skills Inventory (B6OMSI)

Introduction: The objective of this research was to identify the appropriate content for an orientation and mobility (O&M) assessment for young children. It is necessary to have a reliable and valid assessment tool to evaluate whether young children are making adequate gains in response to early intervention efforts in O&M. Very little literature exists on the O&M needs of children aged birth to 6 years because of the roots in adult rehabilitation of the field of O&M. Methods: A group of expert-level professionals in the field of early intervention O&M engaged in a consensus process to establish face validity and content validity of the assessment items, which was accomplished using a Delphi study to identify relevant topics for assessment as a first step in developing a research-based assessment tool. Cutoffs for agreement were established prior to analysis, with 90% consensus for face and content validity of a high-stakes assessment that allows the score on the assessment to serve as a snapshot of a child’s progress. Results: All skills and concepts on the assessment were validated, and seven new items were added. Discussion: The resultant assessment tool is comprehensive in measuring the areas of O&M for young children that specialists found useful for determining the need for services and monitoring progress, does not contain extraneous test questions, and can stand alone as a snapshot of student progress. One item was added to the background information portion of the assessment tool because of its usefulness to some practitioners despite a consensus level below 90%. Future research should seek to establish construct validity and reliability measures. Implications for practitioners: Orientation and mobility specialists can begin using the updated item tool with improved content validity available from the New Mexico School for the Blind website.

Vision Development Differences between Slow and Fast Motor Development in Typical Developing Toddlers: A Cross-Sectional Study

Many studies have established a relationship between visual function and motor development in toddlers. This is the first report to study two-year-olds via an assessment of their visual and motor skills. The purpose of this study is to describe the possible changes that can occur between visual and motor systems in typical developing toddlers. A total of 116 toddlers were included in this observational, descriptive, and cross-sectional study. Their mean age was 29.57 ± 3.45 months. Motor development variables studied were dominant hand/foot; stationary, locomotion, object manipulation, grasping, visual motor integration percentiles; gross motor, fine motor, and total motor percentiles; and gross motor, fine motor, and total motor quotients. Visual development variables were assessed including visual acuity, refractive error, ocular alignment, motor fusion and suppression, ocular motility, and stereopsis. Our findings demonstrated that typical developing toddlers with slow gross motor development had higher exophoria and further near point of convergence values compared to toddlers with fast gross motor development (p < 0.05). No statistically significant differences were found in visual acuity and stereopsis between slow and fast gross motor development toddlers.

Impaired fine motor skills in children following extraction of a dense congenital or infantile unilateral cataract

PURPOSE

To evaluate fine motor ability in children treated for unilateral congenital or infantile cataract.

METHODS

Twenty-three children 3-13 years of age who were treated for unilateral congenital or infantile cataract and 38 age-similar control children were enrolled. Children completed five fine motor skills tasks (unimanual dexterity, bimanual dexterity, drawing trail, aiming, catching) from the Movement Assessment Battery for Children-2. Raw scores were converted into standardized scores, with higher scores indicating better performance.

RESULTS

Compared with controls, children treated for unilateral cataract scored lower on drawing trail (P = 0.009), aiming (P = 0.009), and catching (P < 0.001) but not on unimanual (P = 0.77) or bimanual dexterity (P = 0.31). Poorer affected eye visual acuity was moderately related to poorer performance for unimanual dexterity (r = -0.47; P = 0.025), bimanual dexterity (r = -0.50; P = 0.014), and catching (r = -0.41; P = 0.051). Those with a poor visual outcome (>0.6 logMAR) had worse performance than those with a good visual outcome (≤0.6 logMAR) for all tasks (all P values, 0.008-0.09) except aiming. Cataract type (congenital, 9; infantile, 14) and sensory fusion by Worth 4-Dot testing at 33 cm (pass, 10; fail, 13) had no effect on fine motor performance (all P values, 0.12-0.98).

CONCLUSIONS

In our study cohort, fine motor deficits were found in children treated for congenital or infantile unilateral cataract.

The impact of monocular vision on motor function and quality of life in survivors of retinoblastoma

BACKGROUND

Monocular vision has been found to have a negative effect on children's motion processing and motor functions. Yet, knowledge of motor function of survivors of retinoblastoma (RB) with monocular vision (due to enucleation, for example) is limited. This study examined motor function and its relationship to visual-related and health-related quality of life (HRQOL) in survivors of RB with monocular vision.

PROCEDURE

Parents of 27 survivors of RB, who underwent an enucleation of one eye resulting in monocular vision, and of 21 typically developing children between the ages of 6 and 12, were administered questionnaires relating to their children's motor function (DCDQ), as well as vision-related function (CVFQ) and HRQOL (PedsQL).

RESULTS

Of the 27 survivors of RB, 7 (25.6%) were found to have difficulties in motor functions, compared with 1 (4.8%) child in the control group. The difficulties were faced mainly in daily function requiring control during movement, including jumping, running, and ball playing. Additionally, significant correlations were found between motor functions and children's QOL. Finally, survivors of RB with monocular vision were found to have lower QOL, specifically physical- and school-related QOL.

CONCLUSION

Survivors of RB who have monocular vision have a higher rate of decreased motor function and lower QOL. These results point to a need for ongoing assessment of survivors of RB to allow timely detection of motor deficits and to institute appropriate therapeutic interventions.

Spectacle Adherence Among Four-Year-Old Children in the Infant Aphakia Treatment Study

PURPOSE

To evaluate spectacle adherence with impact-resistant lenses among 4-year-old children after unilateral cataract surgery in the Infant Aphakia Treatment Study.

DESIGN

Retrospective cohort analysis of randomized clinical trial data.

METHODS

Setting: Multicenter.

PATIENTS

One hundred and fourteen children randomized to contact lens correction or intraocular lens implantation following unilateral cataract surgery during infancy.

INTERVENTION

One-week diaries completed annually and retrospective telephone interviews conducted every 3 months to age 5 years to assess spectacle adherence with impact-resistant lenses. Visual acuity was assessed by a traveling examiner at age 4.5 years.

MAIN OUTCOME MEASURES

Spectacle adherence between ages 4 and 5 years.

RESULTS

Children with 20/40 or better vision in their treated eye were more likely to wear spectacles ≥80% of their waking hours than children with vision worse than 20/40 (66% vs 42%, P = .034). Reported adherence to spectacle wear correlated with reported patching (r = 0.30, P = .002). Spectacle adherence did not correlate with sex, type of healthcare insurance, or the refractive error in the treated or fellow eye. Seven patients with reduced vision in their treated eye reported <10% spectacle adherence.

CONCLUSIONS

These results confirm that it is possible to achieve high levels of spectacle adherence among 4-year-old children after unilateral cataract surgery during infancy. However, children with vision worse than 20/40 in their worse eye, who needed eye protection the most, had the worst adherence.

Correlation of monocular grating acuity at age 12 months with recognition acuity at age 4.5 years: findings from the Infant Aphakia Treatment Study

PURPOSE

To determine whether grating acuity at age 12 months can be used to predict recognition acuity at age 4.5 years in children treated for unilateral congenital cataract enrolled in the Infant Aphakia Treatment Study (IATS).

METHODS

Traveling testers assessed monocular grating acuity at 12 months of age (Teller Acuity Card Test [TACT]) and recognition acuity at 4.5 years of age (Amblyopia Treatment Study Electronic Visual Acuity Testing, HOTV) in children treated for visually significant monocular cataract in the IATS. Spearman rank correlation was used to evaluate the relationship between visual acuities at the two ages in the treated eyes.

RESULTS

Visual acuity data at both ages were available for 109 of 114 children (96%). Grating acuity at 12 months of age and recognition acuity at 4.5 years of age were significantly correlated for the treated eyes (r_spearman = 0.45; P = 0.001). At age 4.5 years, 67% of the subjects who had grating acuity at 12 months of age within the 95% predictive limits in their treated eye demonstrated recognition acuity better than 20/200. Similarly, at age 4.5 years 67% of the subjects who had grating acuity at age 12 months below the 95% predictive limits in their treated eye demonstrated recognition acuity of 20/200 or worse.

CONCLUSIONS

A single grating acuity assessment at age 12 months predicts recognition acuity in a child treated for unilateral congenital cataract in only two-thirds of cases. Clinicians should consider other factors, such as patching compliance and age at surgery, when using an early grating acuity assessment to modify treatment.

Global motion perception is related to motor function in 4.5-year-old children born at risk of abnormal development

Global motion perception is often used as an index of dorsal visual stream function in neurodevelopmental studies. However, the relationship between global motion perception and visuomotor control, a primary function of the dorsal stream, is unclear. We measured global motion perception (motion coherence threshold; MCT) and performance on standardized measures of motor function in 606 4.5-year-old children born at risk of abnormal neurodevelopment. Visual acuity, stereoacuity and verbal IQ were also assessed. After adjustment for verbal IQ or both visual acuity and stereoacuity, MCT was modestly, but significantly, associated with all components of motor function with the exception of fine motor scores. In a separate analysis, stereoacuity, but not visual acuity, was significantly associated with both gross and fine motor scores. These results indicate that the development of motion perception and stereoacuity are associated with motor function in pre-school children.

Pharmacological approaches to restoring lens transparency: Real world applications

Cataract is the most common cause of blindness and a major cause of visual impairment worldwide. As the world's population ages, cataract-induced visual impairment is of increasing prevalence, and treatment is limited to those with access to surgical care. While cataracts are mainly a disease of the elderly, infantile cataracts lead to lifelong visual impairment if untreated. Even in those with surgical treatment early in life, visual prognosis is often guarded. Consequently, there is an increasing impetus for alternative therapeutic modalities. Makley and Zhao utilize two different experimental approaches to identify novel pharmacological substances able to improve lens transparency by reducing aggregation of crystalline proteins. These data support an alternative to surgical correction that may be applied to adult patients without access to surgical care as well as address the unique challenges of infantile cataracts.

Behaviors of children with unilateral vision impairment in the Infant Aphakia Treatment Study

PURPOSE

To determine whether behavioral functioning of 4.5-year-olds differs between two treatments for unilateral cataract and whether behavioral functioning is predicted by visual acuity in the treated eye.

METHODS

The Infant Aphakia Treatment Study is a multicenter clinical trial in which 114 infants with unilateral congenital cataracts were randomized to undergo cataract extraction with contact lens correction or implantation of an intraocular lens. Patching data were collected during the year preceding a visit at age 4.5 years, when both visual acuity and caregiver-reported behavioral functioning were assessed for 109 participants. Caregiver stress was assessed with the Parenting Stress Index at 4.25 years.

RESULTS

There were no treatment group differences in behavioral functioning as measured by the Child Behavior Checklist. Poorer visual acuity was associated with more externalizing behavior problems (attention problems and aggressive behavior) and total behavior problems in regression models that did not include caregiver stress. Both caregiver stress and dichotomized visual acuity significantly predicted externalizing problems.

CONCLUSIONS

Treatment assignment did not affect caregiver-reported behavior. Poor visual acuity may confer risk for problems with attention and aggressive behavior in preschoolers treated for unilateral cataract.