Pursuit eye movements in late-onset esotropia

Timing of surgery for infantile esotropia: sensory and motor outcomes

Infantile esotropia is a common ophthalmic disorder in childhood. It is often accompanied by profound maldevelopment of stereopsis, motion processing, and eye movements, despite successful surgical realignment of the eyes. The proper timing of surgery has been debated for decades. There is growing evidence from clinical and animal studies that surgery during the early critical periods enhances sensory and ocular motor development. The Congenital Esotropia Observational Study has defined a clinical profile of infants who will benefit most from early surgery, and several other studies have shown that early surgery does not lead to adverse long-term effects. Clinicians now should consider offering early surgery to patients with large-angle, constant infantile esotropia at or before 10 months of age.

Movimentos oculares no bebê: o que eles nos indicam sobre o status oftalmológico e neurológico

Movimentos oculares anormais podem ser o resultado de um desenvolvimento visual anormal ou estar sinalizando a existência de uma doença neurológica ou neuromuscular. Assim, é importante que o clínico conheça essas anormalidades e possa distingui-las dos movimentos oculares normais, porém imaturos. Este trabalho oferece esclarecimentos sobre os diferentes tipos de movimentos oculares, como interpretá-los nos bebês saudáveis e quais os tipos de alterações encontradas nas diferentes doenças visuais e neurológicas.

Motion detection in normal infants and young patients with infantile esotropia

The purpose of this study was to investigate asymmetries in detection of horizontal motion in normal infants and children and in patients with infantile esotropia. Motion detection thresholds (% motion signal) were measured in 75 normal infants and in 36 eyes of 27 infants with infantile esotropia (ET), using a forced-choice preferential looking paradigm with random-dot patterns. Absolute motion detection sensitivity and asymmetries in sensitivity for nasalward (N) vs. temporalward (T) directions of motion were compared in normal and patient populations, ranging in age from 1 month to 5 years. In normal infants, N and T thresholds were equivalent under 2.5 months of age, whereas a superiority for monocular detection of N motion was observed between 3.5 and 6.5 months of age. The nasalward advantage gradually diminished to symmetrical T:N performance by 8 months of age, matching that of adults. No asymmetry was observed in 15 normal infants who performed the task binocularly, hence, the asymmetry was not a leftward/rightward bias. In the youngest infantile ET patients tested, at 5 months of age, a nasalward superiority in motion detection was observed and was equivalent to that of same-age normal infants. However, unlike normals, this asymmetry persists in older patients. This greater asymmetry in infantile ET represents worse detection of T than N motion. This is the first report of an asymmetry in motion detection in normal infants across a wide age range. Initially, motion detection is normal in infants with infantile esotropia. Cumulative abnormal binocular experience in these patients may disrupt motion mechanisms.

Abnormal supranuclear eye movements in the child: a practical guide to examination and interpretation

Abnormal eye movements in the infant or voting child can be congenital or acquired. They may be a result of abnormal early visual development or a sign of underlying neurologic or neuromuscular disease. It is important to be able to detect these abnormalities and to distinguish them from normal but immature eye movements. The spectrum of disease in children differs from that in adults. Serious, potentially fatal but treatable disorders can be acquired in infancy, and abnormal eye movements in a sometimes apparently well child should never be labeled as congenital or benign without careful investigation. Eye movement analysis can indicate the presence of an underlying condition and help the clinician to classify different neurologic diseases. It is important to carefully examine the ocular motor system in any children at risk of neurologic disease. This review provides a practical guide to the examination and interpretation of eye movements in the child and includes recent literature on eye movement disorders of childhood. We describe supranuclear abnormalities of the ocular motor system in the order in which we would normally examine it: saccades, pursuit, convergence, vestibulo-ocular reflex, and optokinetic nystagmus. Nystagmus, internuclear ophthalmoplegia, cranial nerve abnormalities, and "miswiring" phenomena (such as Duane's syndrome and synergistic divergence) are not discussed.

The relationship between stereopsis and monocular optokinetic optokinetic nystagmus after infantile cataracts

PURPOSE

Visual deprivation disrupting binocular development, such as that occurring with congenital cataract, is reported to cause asymmetric monocular optokinetic nystagmus (MOKN), as well as poor sensory and motorfusional outcome. We wanted to determine if symmetric MOKN could develop in cases of congenital cataract with good fusional outcome.

METHODS

We tested MOKN (with video and electro-oculographic recordings) and stereoacuity on 5 patients with good visual acuity and satisfactory ocular alignment after surgery for congenital cataract.

RESULTS

Stereoacuity was better than 50 seconds of arc in 1 case of monocular cataract and 2 cases of bilateral cataract. These case patients had symmetric MOKN. In a monocular cataract case, symmetric MOKN was observed in spite of questionable stereoacuity (at least 500 arc/s). One patient showed asymmetric MOKN, despite good visual acuity, and stereoacuity of 200 arc/s.

CONCLUSIONS

Patients with congenital cataract can have symmetric MOKN and good stereopsis. These cases suggest that MOKN symmetry develops along with good stereopsis, but the quality of stereopsis necessary for development of MOKN symmetry remains unclear.

Biases of motion perception revealed by reversing gratings in humans who had infantile-onset strabismus

Motion perception was tested by requiring adult subjects to view gratings that remained stationary but reversed in contrast several times per second. Subjects viewed monocularly and judged whether the gratings were stationary, or moving in one direction, in successive 3s trials. Subjects who had early-onset strabismus most frequently perceived vertically oriented gratings to be moving nasalward, and horizontally oriented gratings to be moving up or down. Normal subjects and subjects who had late-onset strabismus most frequently perceived the gratings to be stationary. The asymmetries of motion perception in early-onset strabismus imply that the visual motion neurons of cerebral cortex develop properly only if they receive normal binocular input during infancy.

Abnormal motion processing and binocularity: infantile esotropia as a model system for effects of early interruptions of binocularity

Infantile esotropia, a common form of strabismus with onset prior to 6 months of age, occurs at a time of rapid visual development. While monocular visual acuity is relatively unaffected in these patients, the majority of them fail to achieve fully normal stereopsis. In addition, these patients show a spectrum of abnormalities in their ocular following responses, visual perception and visual evoked potentials (VEPs) that suggest a failure to develop a normal complement of motion processing mechanisms. While abnormalities of of stereopsis have been studied for many years, motion processing in strabismus is a rapidly evolving area of current research. Motion mechanisms are normally binocular and may form a distinct binocular sub-system. This review summarises which is known about sensory and motor abnormalities in infantile esotropia, with special emphasis on recent motion VEP recordings. The monocular motion VEP shows directional biases early in infancy that are consistent with a nasalward/temporalward response bias. Patients with infantile esotropia maintain their neonatal biases beyond the age at which they normally disappear. The motion VEP biases persist into visual maturity in patients whose strabismus is treated after about 2 years of age. Treatment prior to age 2 can lessen the magnitude of the motion VEP asymmetry and these improvements can be maintained into visual maturity. A recording from the striate cortex of a visually deprived macaque monkey indicates that the motion VEP asymmetry arises early in the visual pathway.

Plasticity of human motion processing mechanisms following surgery for infantile esotropia

Monocular oscillatory-motion visual evoked potentials (VEPs) were measured in prospective and retrospective groups of infantile esotropia patients who had been aligned surgically at different ages. A nasalward-temporal response bias that is present prior to surgery was reduced below pre-surgery levels in the prospective group. Patients in the retrospective group who had been aligned before 2 yr of age showed lower levels of response asymmetry than those who were aligned after age 2. The data imply that binocular motion processing mechanisms in infantile esotropia patients are capable of some degree of recovery, and that this plasticity is restricted to a critical period of visual development.