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Does neonatal ocular misalignment predict later abnormality?
1Orthoptic Department, Royal Berkshire Hospital, Reading, UK. a.m.horwood@reading.ac.uk
Insights
Frequent neonatal squinting, or ocular misalignment, in infants significantly increases the risk of needing glasses for refractive errors like hypermetropia and myopia by age five. Occasional squinting is considered normal infant behavior.
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%.
Purpose:
A longitudinal prospective study was carried out to ascertain the significance of neonatal ocular misalignments.
Methods:
Pre-school vision screening and hospital records were examined to determine the visual outcome of 1150 infants classified into 'often' (> 15% of waking hours), 'occasionally' (< 15%) or 'never' having an ocular misalignment (neonatal squint) in the first 8 weeks of life. Chi2 and Fisher's exact tests and ANOVA were used to analyse the data.
Results:
When compared with infants who had squinted occasionally or never, frequent squinting in the neonatal period (which occurred in 7.7% of the subjects) was significantly associated with having been prescribed spectacles (p = 0.04), both for hypermetropia (p = 0.04) and for myopia (p = 0.05). Frequent squinters also had a higher incidence of significant esodeviation (p = 0.04) and were more likely to be > 21 days premature (p = 0.05). Small numbers of abnormalities made statistical analysis limited, but there were weak trends towards more myopic and oblique astigmatism in the 'never' group. The esotropias in the 'often' group were more frequently intermittent than those found in the other groups.
Conclusions:
Occasional squinting in the first 8 weeks of life appears to be normal neonatal behaviour. Frequent squinting trebles the chances of developing a significant esodeviation or refractive error severe enough to require spectacles before 5 years of age but incidence of abnormality still does not exceed 9%.