Cerebral Palsy for the Pediatric Eye Care Team Part II: Diagnosis and Treatment of Ocular Motor Deficits
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Insights
Strabismus and eye movement disorders are common in children with cerebral palsy (CP). While surgery can successfully manage many cases, vision therapy shows limited effectiveness for CP-related visual deficits.
Area of Science:
- Ophthalmology
- Neurology
- Pediatrics
Background:
- Cerebral palsy (CP) encompasses neurological deficits from developmental damage.
- This study focuses on ocular motor deficits, including strabismus and eye movement abnormalities, in children with CP.
Purpose of the Study:
- To determine the frequency and types of strabismus in children with CP.
- To evaluate the impact of CP on eye movement systems.
- To assess the efficacy of vision therapy and strabismus surgery for ocular motor deficits in CP.
Main Methods:
- Retrospective chart review of 131 children with CP at St. Louis Children's Hospital Eye Center.
- Data collected included sensory and motor deficits, management strategies, and treatment responses.
- Analysis of strabismus types, eye movement disorders (fixation, pursuit, saccades, vergence), and surgical outcomes.
Main Results:
- 64% of children with CP had strabismus (55% esotropia, 27% exotropia).
- Prevalence of eye movement deficits: 61% fixation instability, 85% pursuit deficit, 80% saccade deficit, 45% vergence deficit.
- Strabismus surgery achieved success in 67% of cases after a mean of 2.1 surgeries, particularly in mild/moderate CP with stable angles. Vision therapy showed limited efficacy.
Conclusions:
- Infantile strabismus and eye movement disorders are significantly more prevalent in children with CP.
- Vision therapy demonstrates no convincing evidence of significant improvement in eye movements or visual function for CP.
- Conventional strabismus surgery offers successful management for approximately two-thirds of non-accommodative strabismus cases in CP, often requiring multiple procedures.
Introduction:
Cerebral palsy is a term used to describe a spectrum of neurological deficits resulting from damage to the developing nervous system. This paper, the second in a series of three articles, will present frequency, diagnosis, and management of the ocular motor deficits associated with CP. Topics for discussion will include the prevalence and type of strabismus, the effect of CP on eye movement systems, the efficacy of vision therapy for eye movement deficits, and strabismus surgery.
Methods:
In 2002, a retrospective chart review of all cases of cerebral palsy referred to the St. Louis Children's Hospital Eye Center was done. Detailed data on the sensory and motor deficits documented in these children was collected. Also recorded was the management strategy and response to treatment.
Results:
Of the 131 cases reviewed (mean age 5.2 years at presentation), 84 (64%) had strabismus: 55% esotropia and 27% exotropia. Of those patients tested for eye movement disorders 67 (61%) had evidence of instability of fixation; 85% of the patients had a pursuit deficit; and 80% had some type of deficit in performing saccades. Vergence was affected in 45% of our patients. Of the patients who underwent strabismus surgery, 67% achieved success after a mean number of 2.1 surgeries. Surgical success was associated with mild or moderate CP (P <.0005), and a stable preoperative angle. Six percent of our patients underwent vision therapy for strabismus or eye movement anomalies under the direction of an outside optometrist.
Conclusion:
Infantile strabismus is significantly more common in children with CP than in the general pediatric population. Disorders of eye movements are also very common. Based on our experience and review of the literature there is no convincing evidence that vision therapy significantly improves eye movements or visual functioning. Approximately 2 of every 3 cases of nonaccommodative strabismus associated with CP can be successfully managed with conventional strabismus surgery, though most children will require at least two surgeries to achieve alignment.
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