Instability of Ocular Alignment in Childhood Esotropia
Received 7 March 2008; received in revised form 7 July 2008; accepted 5 August 2008. published online 29 October 2008.
Objective
Instability of ocular alignment may cause surgeons to delay surgical correction of childhood esotropia. The authors investigated the stability of ocular alignment over 18 weeks in children with infantile esotropia (IET), acquired nonaccommodative esotropia (ANAET), or acquired partially accommodative esotropia (APAET).
Design
Prospective, observational study.
Participants
Two hundred thirty-three children aged 2 months to less than 5 years with IET, ANAET, or APAET of less than 6 months' duration.
Methods
Ocular alignment was measured at baseline and at 6-week intervals for 18 weeks.
Main Outcome Measures
Using definitions derived from a nested test–retest study and computer simulation modeling, ocular alignment was classified as unstable if there was a change of 15 prism diopters (PD) or more between any 2 of the 4 measurements, as stable if all 4 measurements were within 5 PD or less of one another, or as uncertain if neither criteria was met.
Results
Of those who completed all 3 follow-up visits within time windows for analysis, 27 (46%) of 59 subjects with IET had ocular alignment classified as unstable (95% confidence interval [CI], 33%–59%), 20% as stable (95% CI, 11%–33%), and 34% as uncertain (95% CI, 22%–47%). Thirteen (22%) of 60 subjects with ANAET had ocular alignment classified as unstable (95% CI, 12%–34%), 37% as stable (95% CI, 25%–50%), and 42% as uncertain (95% CI, 29%–55%). Six (15%) of 41 subjects with APAET had ocular alignment classified as unstable (95% CI, 6%–29%), 39% as stable (95% CI, 24%–56%), and 46% as uncertain (95% CI, 31%–63%). For IET, subjects who were older at presentation were less likely to have unstable angles than subjects who were younger at presentation (risk ratio for unstable vs stable per additional month of age, 0.85; 99% CI, 0.74–0.99).
Conclusions
Ocular alignment instability is common in children with IET, ANAET, and APAET. The impact of this finding on the optimal timing for strabismus surgery in childhood esotropia awaits further study.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Available online: October 20, 2008.
Correspondence: Stephen P. Christiansen, MD, c/o Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647 E-mail: PEDIGETS1Combined@jaeb.org
Manuscript no. 2008-302.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Supported by the National Institutes of Health, Bethesda, Maryland (grant no.: EY011751).
Writing Committee. Lead authors: Stephen P. Christiansen, MD; Danielle L. Chandler, MSPH; and Jonathan M. Holmes, BM, BCh. Additional writing committee members (alphabetical order): Robert W. Arnold, MD; Eileen Birch, PhD; Linda R. Dagi, MD; Darren L. Hoover, MD; Deborah L. Klimek, MD; B. Michele Melia, ScM; Evelyn Paysse, MD; Michael X. Repka, MD; Donny W. Suh, MD; Benjamin H. Ticho, MD; David K. Wallace, MD; and Richard Grey Weaver, Jr., MD.
ABSTRACT