Preliminary report: monocular spatial localization in children with strabismic amblyopia

Defective spatial localization is an important feature of strabismic amblyopia. Based on our experience from testing adult strabismics under various test conditions, we developed a test for assessing vertical alignment in strabismic children. Patients had to align a vertical test line with the apices of two vertically arranged reference triangles, under the control of both the dominant eye and the amblyopic eye. Means and standard deviations of several judgements represent systematic errors and uncertainty of alignment. We tested 27 strabismic and 34 age-matched control children aged 4.5-10 years. Control children showed a scatter of mean systematic alignment around the correct position of up to 7 minarc. In the amblyopic eyes of strabismic children, uncertainty was consistently higher than in the eyes of the control children. Systematic errors outside the normal range frequently occurred. In children tested repeatedly during occlusion therapy, uncertainty decreased as visual acuity improved. In several cases we observed changes of systematic vertical alignment during therapy, sometimes unexpectedly in the sense of a change in the direction of mislocalization or an initial increase and later decrease of errors. Thus, children with strabismic amblyopia show spatial localization deficits which are similar to those of adult strabismic amblyopes. Both spatial uncertainty and systematic distortions are susceptible to change due to enforced use of the amblyopic eye during occlusion therapy.