Factors Associated With Impaired Motor Skills in Strabismic and Anisometropic Children
abstract
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Access this abstract nowPurpose
We evaluated motor skills in children diagnosed with strabismus and anisometropia, with or without amblyopia, and explored factors associated with impairments.
Methods
A total of 143 strabismic and anisometropic children 3 to 13 years of age (96 amblyopic, 47 nonamblyopic) and a group of age-similar 35 control children completed Manual Dexterity, Aiming and Catching, and Balance tasks from the Movement Assessment Battery for Children, Second Edition. Raw scores were converted to standardized scores, and amblyopic and nonamblyopic children were compared to controls. Clinical and sensory factors associated with motor performance were also evaluated.
Results
Overall, amblyopic and nonamblyopic children were three to six times more likely than controls to be at risk for or to have a total motor impairment (≤15th percentile). Although amblyopic children scored lower than controls for the Manual Dexterity, Aiming and Catching, and Balance tasks, nonamblyopic children scored lower on Manual Dexterity only. Factors related to manual dexterity deficits include the presence of amblyopia and binocularity deficits typical of these eye conditions. Aiming, catching, and balance deficits were most pronounced in children with an infantile onset of the eye condition, a history of strabismus, and reduced binocularity.
Conclusions
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.
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Factors Associated With Impaired Motor Skills in Strabismic and Anisometropic Children
Invest. Ophthalmol. Vis. Sci 2020 Aug 03;61(10)43, KR Kelly, SE Morale, CL Beauchamp, LM Dao, BA Luu, EE BirchFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This is the latest in a series of papers from Kelly, Birch, and their colleagues at the Retina Foundation of the Southwest, showing that children with strabismic and anisometropia amblyopia have impaired motor skills relative to their binocularly normal peers in this age-matched control study. This study 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 six 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 thus warrants more comprehensive assessment and treatment.
Amblyopia is the most common cause of unilateral visual impairment in children in developed countries and affects 2% to 4% of children. This could cause disruption in fine and gross motor skills, which has implications for academic and sports activities. Birch at al report a very relevant paper on the motor skills in children with strabismus and anisometropia. The authors used a standardized test to assess motor skills—the Movement Assessment Battery for Children. In their study, they found that children with strabismus and anisometropia were three to six times more likely than controls to have a total motor impairment. Particularly aiming, catching, and balance deficits were more pronounced in infantile onset. The other interesting observation was that children who had successfully treated amblyopia fared similarly to children with no amblyopia. This observation is very critical to understand the importance of timely management of pediatric eye conditions. Although the effects of amblyopia on motor skills has been known,1 this well-conducted study brings attention to this topic and emphasizes the need for early diagnosis of strabismus and anisometropia by screening methods employed by the pediatrician.
Reference