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A Method to Quantify Visual Information Processing in Children Using Eye Tracking
Published on: July 9, 2016
Changes in astigmatism in children with congenital nystagmus
J Jethani1, K Prakash, P Vijayalakshmi
1Paediatric Ophthalmology and Strabismus, Aravind Eye Hospitals, 1, Annanagar, 625020, Madurai, India. xethani@rediffmail.com
Insights
Children under 4 with congenital nystagmus are more likely to develop with-the-rule (WTR) astigmatism as they grow. Visual acuity remains stable in both younger and older children with nystagmus.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus and Amblyopia
Background:
- Astigmatism is frequently observed in children, with or without nystagmus.
- In children without nystagmus, astigmatism typically shifts from against-the-rule (ATR) to with-the-rule (WTR) before age 4.
- Little is known about astigmatism progression in children with congenital nystagmus.
Purpose of the Study:
- To compare astigmatism development in children with congenital nystagmus younger than 4 years versus those 4 years and older.
- To investigate the incidence of WTR astigmatism in these age groups.
- To analyze changes in visual acuity over time.
Main Methods:
- A cohort of 178 children (356 eyes) with congenital nystagmus was analyzed.
- Children were stratified into two groups: under 4 years (192 eyes) and 4 years or older (164 eyes).
- Cycloplegic refraction was performed at initial presentation and last follow-up, with visual acuity recorded at both time points.
Main Results:
- Nearly half of the eyes (49.44%) had no astigmatism at presentation.
- A significant proportion (25.2%) of children under 4 years without initial astigmatism developed WTR astigmatism (p=0.042).
- In contrast, only 9.6% of children 4 years and older developed WTR astigmatism; visual acuity remained stable in both groups.
Conclusions:
- The incidence of WTR astigmatism in children with congenital nystagmus aligns with previous reports.
- Younger children (<4 years) with congenital nystagmus have a higher likelihood of developing WTR astigmatism compared to older children.
- Astigmatism may increase with age in children with nystagmus, while visual acuity remains stable.
Background:
Astigmatism is commonly reported in children with and without nystagmus. In children less than 4 years of age the astigmatism changes from against the rule (ATR) to with the rule (WTR) astigmatism in children without nystagmus. However, little is known about children with congenital nystagmus. We compared astigmatism in children with congenital nystagmus below 4 years and above 4 years of age.
Material And Methods:
Three hundred and fifty-six eyes in 178 children who satisfied the study criteria were included. The children were divided into those below 4 years of age (n of eyes = 192) and those above (n of eyes = 164). Cycloplegic refraction (with manual retinoscopy) carried out at presentation and at the last follow-up were recorded and compared. Cycloplegia was achieved using cyclopentolate eye drops. Outcome of eyes with no astigmatism at initial presentation was compared with the final refraction in both the age groups. The visual acuity at the first presentation was compared with the visual acuity at the last presentation.
Results:
Average follow-up duration was 3.36+/-1.59 years. On presentation, 176 (49.44%) eyes did not have any astigmatism. We found that 26 (25.2%) out of the 103 children below 4 years of age who did not have any astigmatism on presentation developed WTR astigmatism after a mean follow-up of 3.5+/-1.5 years. (p= 0.042). In children >or=4 years of age only 7 (9.6%) children out of 73 developed WTR after a mean follow-up of 3.4+/-1.4 years. The visual acuity change was not found to be significant in the two groups. The majority (90.3%) improved or had same visual acuity in group A and 88.9% improved or had the same visual acuity in group B at the last follow-up (p= 0.77).
Discussion:
Our incidence of WTR astigmatism in children with congenital nystagmus is similar to those previously reported series. Our data suggest that there is a significant chance that children under 4 years with congenital nystagmus may develop WTR astigmatism compared with children above 4 years of age.
Conclusion:
With the rule (WTR) astigmatism is common in children with nystagmus. Children under 4 years of age presenting with no astigmatism may acquire WTR astigmatism as they grow. The amount of astigmatism increases with age in children with nystagmus. Visual acuity, however, remains stable as the age advances.
