Does neonatal ocular misalignment predict later abnormality?

Area of Science:

• Ophthalmology
• Developmental Pediatrics
• Neonatology

Background:

• Neonatal ocular misalignments, commonly known as squint, are frequently observed in newborns.
• The long-term visual significance of these early misalignments requires further investigation.

Purpose of the Study:

• To determine the significance of neonatal ocular misalignments.
• To investigate the visual outcomes associated with neonatal squint.

Main Methods:

• A longitudinal prospective study of 1150 infants was conducted.
• Infants were classified based on the frequency of ocular misalignment (squint) in the first 8 weeks of life: 'often', 'occasionally', or 'never'.
• Data were analyzed using Chi2 and Fisher's exact tests and ANOVA, comparing visual outcomes from pre-school vision screening and hospital records.

Main Results:

• Frequent neonatal squinting (7.7% of subjects) was significantly associated with needing spectacles for hypermetropia (p=0.04) and myopia (p=0.05).
• Frequent squinters showed a higher incidence of significant esodeviation (p=0.04) and were more likely to be premature (p=0.05).
• While trends suggested more myopic and oblique astigmatism in the 'never' group, esotropias in the 'often' group were more frequently intermittent.

Conclusions:

• Occasional neonatal squinting is considered normal infant behavior.
• Frequent neonatal squinting triples the risk of developing significant esodeviation or refractive errors requiring spectacles by age five.
• The overall incidence of significant abnormality in frequent squinters does not exceed 9%.