A Study of Ocular Disease and Treatment in Patients with Developmental Disability

Hyo Sung Yoon; Joo Yeon Lee; Yoon Ae Cho

doi:10.3341/jkos.2014.55.2.261

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Yoon, Lee, and Cho: A Study of Ocular Disease and Treatment in Patients with Developmental Disability

Original Article

J Korean Ophthalmol Soc 2014;55(2):261-266.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.2.261

A Study of Ocular Disease and Treatment in Patients with Developmental Disability

Hyo Sung Yoon, MD¹, Joo Yeon Lee, PhD¹, Yoon Ae Cho, MD, PhD²

¹Department of Ophthalmology, Hallym University College of Medicine, Anyang, Korea

²Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea

Address reprint requests to Yoon Ae Cho, MD, PhD Department of Ophthalmology, Korea University Medical Center, #73 Inchon-ro, Seongbuk-gu, Seoul 136-705, Korea, Tel: 82-2-920-5114, Fax: 82-2-924-6820, E-mail: earth317@yahoo.co.kr

Received 21 June 201327 September 2013 Accepted 20 December 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate ocular abnormalities in children with developmental disability and to find out whether any correlation exists between developmental disability and surgical outcome.

Methods

Totally 43 patients with the diagnosis of developmental disability were enrolled in this retrospective study.

Results

Mean follow-up was 4.54 ± 2.35 year. 20 patients had exodeviation, 15 patients had esodeviation, 10 patients had dissociated vertical deviation and 4 patients had dyskinetic strabismus. 21 patients had surgery and the mean deviation angle was decreased from 36.67 ± 15.70 PD to 5.33 ± 5.93 PD in exotropia and 56.25 ± 8.54 PD to 5.75 ± 4.65 PD in esotropia. Refractive error was found in 33 patients (88.4%). 26 patients (60.5%) had monocular amblyopia and 17 patients (65.38%) showed improvement of visual acuity after treatment.

Conclusions

Exotropia is the most common type strabismus in patients with developmental disability and dyskinetic strabismus is found in cerebral palsy. Strabismus Surgery for patients with stable angle deviation and amblyopia treatment is effective in children with developmental disability. However decision for surgery should be made after a long follow up period.

Keywords: Amblyopia, Developmental disability, Refractive error, Strabismus, Strabismus surgery

References

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Table 1.

Etiology of developmental disability

	No. of patients (%)
Cerebral Palsy
Spastic	6 (14.0)
Athetosis	3 (7.0)
Others	14 (32.6)
Seizure Disorder	6 (14.0)
Prematurity	1 (2.3)
Idiopathic	13 (30.2)

Table 2.

Age distribution at initial visit and surgery

Age (years)	No of patients (%)
Age (years)	Initial visit	Surgery
≤ 2	12 (27.9)	1 (4.8)
>2-6	21 (48.8)	8 (38.1)
>6-15	9 (20.9)	10 (47.6)
>15	1 (2.3)	2 (9.5)
Total	43 (100)	21 (100)

Table 3.

Frequency of ophthalmic disease among 43 patients with developmental disability

Disease	No of patients (%)
Constant exotropia	9 (20.9)
Intermittent exotropia	11 (25.6)
Basic esotropia	2 (4.7)
Congenital esotropia	7 (16.3)
Refractive accommodative esotropia	4 (9.3)
Nonrefractive accommodative esotropia	1 (2.3)
Dissociated vertical deviation	9 (20.9)
Dissociated horizontal deviation	1 (2.3)
Dyskinetic strabismus	4 (9.3)
Superior oblique palsy	1 (2.3)

Table 4.

Angle of deviation of horizontal strabismus

Deviation angle (PD)	No. of patients (%)
Deviation angle (PD)	Exotropia	Esotropia
<20	1 (4.3)	1 (6.2)
20< <35	7 (30.4)	4 (25.0)
35< <50	9 (39.1)	3 (18.8)
≥50	3 (12.9)	6 (37.5)

PD = prism diopter.

Table 5.

Pre and postoperative deviation angle

	Preoperative Angle (PD)	Postoperative angle (PD)
	Preoperative Angle (PD)	3 weeks	6 months	Last follow-up
XT	-39.63 ± 18.50	+10.23 ± 5.48	-1.54 ± 5.36	-3.69 ± 6.52
ET	+40.30 ± 14.23	+3.50 ± 4.12	+4.50 ± 5.74	+3.75 ± 6.84
HT	13.75 ± 8.66	0 ± 2.49	0.50 ± 1.74	0.25 ± 1.39

Values are presented as mean ± SD.

XT = exotropia; ET = esotropia; HT = hypertropia; - = exodeviation; + = esodeviation.

Table 6.

Course of strabismus

	No. of patients (%)
Spontaneous improvement
XT	2 (4.8)
ET	2 (4.8)
Spontaneous consecutive exodeviation	3 (7.3)
Surgery	21 (51.2)
Secondary surgery for recurrent exotropia	1 (2.4)

Table 7.

Frequency of ocular abnormalities except strabismus

Disease	No of patients (%)
Latent nystagmus	5 (11.6)
Manifest nystagmus	3 (7.0)
Congenital ptosis	1 (2.3)
Amblyopia (monocular)	26 (60.5)
Refractive error (>±0.50)	33 (88.4%)

Table 8.

Distribution of refractive errors

Refractive error (spherical equivalent)	No of eyes (%)
Emmetropia (<±0.50D)	10 (11.6)
Hyperopia
+0.50D < < +2.00D	13 (15.1)
+2.00D < < +4.00D	8 (9.3)
Myopia
-0.5D < < -2.00D	24 (27.9)
-2.00D < < -4.00D	20 (23.3)
-4.00D < < -8.00D	9 (10.5)
>-8.00D	2 (2.3)

D = diopter.

Table 9.

Monocular corrected visual acuity improvement after amblyopia treatment

Visual acuity Improvement (lines)	No of patients (%)
Visual acuity Improvement (lines)	6 month^*	1 year^*	Last follow-up
1	9	8	5
2	3	2	2
3	2	5	5
≥4	3	4	10

^* Duration of amblyopia treatment.

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