Improvement in motor development following surgery for infantile esotropia

Abstract

Purpose-Infantile esotropia is associated with abnormal visual development and thus may delay the achievement of developmental milestones. Although early surgery can improve visual function, less is known about its effect on motor development. Here we address whether early surgery can improve motor development.Methods-Recently, our lab devised the Infant Developmental Skills Survey, a 25-item questionnaire designed to assess sensorimotor and gross motor development. The questionnaire was completed by the parents of 3-10 month-old patients with infantile esotropia prior to surgery (N = 143) and the parents of 6-11 month-old patients following surgery (N = 58). A subset of parents (N = 40) completed the questionnaire both before and after surgery. For comparison, the questionnaire was completed by the parents of infants with normal ocular alignment (N = 194).Results-Before surgery, 4, 5, 6, 7, 9 and 10 month-old patients showed delayed achievement of sensorimotor milestones (p < 0.01) and 5, 9 and 10 month-old patients demonstrated delayed attainment of gross motor milestones (p < 0.05) compared to normal children. However, following surgery, patients demonstrated a greater rate of sensorimotor development than age-matched controls (p<0.0001) and caught up with normal children on both sensorimotor and gross motor skills.Conclusions-Prior to surgery, patients with infantile esotropia were delayed in their achievement of developmental milestones. However, following surgery, a comparison group of patients showed rapid development and possessed motor skills comparable to those of normal children, suggesting that early surgery is beneficial to both visual and motor development.It is widely accepted that infantile esotropia is associated with severe deficits of stereopsis and fusion. 1,2 Given the normal rapid development of stereopsis and fusion between 3 and 8 months of age, 3-5 it is possible that infantile esotropia negatively impacts the achievement of early developmental motor milestones (grasping objects, walking, and crawling) which rely, at least to an extent, on normal visual development. 6 Poor stereoacuity has been shown to impede motor skills in older children. Recently, in a study of preschoolers investigating the effects of unilateral visual impairment, Hrisos et al. 7 found that reduced stereoacuity is associated with poor performance on tasks assessing hand-eye coordination and visuomotor skills. 7The visual outcomes of patients with infantile esotropia are substantially improved if the misalignment is corrected surgically early in life. Recent reports suggest that early muscle surgery is associated with greater prevalence of stereopsis and fusion along with reducedThe authors have no commercial interest Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is p...

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Stereo vision and strabismus

“…[83][84][85][86][87][88][89][90] Stereoacuity has also been linked to better reading ability, 91,92 perhaps because both stereopsis and reading require precise control of eye movements. 93 Untreated children with infantile esotropia lag behind on developmental milestones but catch up following early alignment surgery (in the first year of life), 94 an outcome that the authors attribute to better binocular vision and stereopsis. However, it remains unclear whether this motor improvement reflects stereopsis specifically or some other aspect of binocular vision.…”

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