Abstract
Purpose: :
Despite a wealth of evidence that esotropia is associated with developmental abnormalities in visual cortical structure and function, there is limited research on its impact on quality of life in children <7 years of age. Here we evaluate quality of life for esotropic preschool children using a previously validated proxy questionnaire, the Children's Visual Function Questionnaire (CVFQ).
Methods: :
Parents of 106 esotropic children age 3-6y completed the CVFQ during the same visit as their child's visual acuity (EVA-HOTV) and random dot stereoacuity (Preschool Randot and Lang Tests). CVFQ data provided 4 sub-scale scores: Competence (15 questions), Personality (9 questions), Family Impact (7 questions) and Treatment Difficulty (6 questions). CVFQ sub-scale scores were compared with data from 47 age-matched normal controls.
Results: :
Esotropic children had significantly worse Competence (t=5.42, p<0.0001) and Family Impact scores (t=9.23, p<0.0001) than normal controls. There was no significant difference in Personality scores between esotropic and control children. Difficulty with patching, atropine, and/or spectacle treatment was reported to occur "always" or "often" by 31% of the 91 parents whose children were under treatment at the time they completed the CVFQ. Among esotropic children, those with nil random dot stereoacuity (n=74) had significantly worse Family Impact scores than those with measureable stereoacuity (n=32) (t=2.37, p=0.03), primarily due to concerns about time spent on medical visits and treatment and reduced time for other family members and activities. Parents of children with nil stereoacuity responded "My child is too young to attempt this" more frequently to the 4 fine motor skills questions in the Competence subscale than did parents of children with measurable stereoacuity (p=0.007). Amblyopia (≥0.2 logMAR interocular difference; n=28) was not associated with decreased Competence subscale scores or increased use of the "My child is too young to attempt this" response.
Conclusions: :
During the preschool years, esotropia has a significant impact on the family, is associated with treatment difficulty, and is associated with reduced competence in fine motor skills. The relationship between reduced competence and nil stereoacuity is consistent with previous reports of delayed developmental milestones in esotropic infants (Drover et al J AAPOS 2008) and deficits in fine motor skills in adults with nil stereoacuity (O'Connor et al IOVS 2010). The association of measurable stereoacuity (even if it is subnormal) with better fine motor skills and reduced family impact underscores the value of preserving or rehabilitating stereoacuity in children with esotropia.
Keywords: esotropia and exotropia • binocular vision/stereopsis • quality of life